Treatment Of Chronic Renal Failure (CRF),

The goal of medical treatment for the patients with Chronic Renal Failure (CRF) is to control symptoms, reduce complications, and slow the progression of the disease and should focus on the following:

a. Delaying or halting the progression of chronic Renal Failure (CRF).

Once CRF has been diagnosed, the physician attempts to determine the cause of Chronic Renal failure (CRF) and, if possible, plan a specific treatment.

Nonspecific treatments are implemented to delay or possibly arrest the progressive loss of kidney function.

b. Aggressive Control of blood pressure to target values per current guidelines : hypertension (high blood pressure)—Target systolic blood pressure (BP) is 120 to 135 mm Hg; target diastolic BP is 70 to 80 mm Hg.

Antihypertensive medication from the ACE class is preferable because of protective effects on the kidneys. Systolic blood pressure control is considered more important and is also considered difficult to control in elderly patients with chronic Renal Failure (CRF).
Use of ACE inhibitors or angiotensin receptor blockers as tolerated, with close monitoring for renal deterioration and for hyperkalemia (avoid in advanced renal failure, bilateral renal artery stenosis [RAS], RAS in a solitary kidney).

Data support the use of ACE inhibitors/angiotensin receptor blockers in diabetic kidney disease with or without proteinuria. However, in nondiabetic renal failure, ACE inhibitors/angiotensin receptor blockers are effective in retarding the progression of disease among patients with proteinuria of less of than 500 mg/d.

Aggressive glycemic control per the American Diabetes Association (ADA) recommendations (target HbA1C <7%). Treating the pathologic manifestations of chronic Renal Failure (CRF), including the following:

Anemia with erythropoietin, with the goal being 11-12 g/dL, as normalization of hemoglobin in patients with chronic Renal Failure (CRF) stages 4-5 has been associated with an increased risk of combined outcome. Before starting Epogen, iron stores should be checked, and the aim is to keep iron saturation at 30-50% and ferritin at 200-500.

Hyperphosphatemia with dietary phosphate binders and dietary phosphate restriction for CRF.

Hypocalcemia with calcium supplements with or without calcitriol and Hyperparathyroidism with calcitriol or vitamin D analogs and Cardiovascular complications.

Volume overload with loop diuretics or ultrafiltrationMetabolic acidosis with oral alkali supplementationUremic manifestations with chronic renal replacement therapy (hemodialysis, peritoneal dialysis, or renal transplantation): Indications include severe metabolic acidosis, hyperkalemia, pericarditis, encephalopathy, intractable volume overload, failure to thrive and malnutrition, peripheral neuropathy, intractable gastrointestinal symptoms, and the GFR less than 10 mL/min.

c.Timely planning for chronic renal Failure (CRF) replacement therapy.

Early education regarding natural renal failure progression, different dialytic modalities, renal transplantation, patient option to refuse or discontinue chronic dialysis.

Timely placement of permanent vascular access (arrange for surgical creation of primary arteriovenous fistula, if possible, and preferably at least 6 months in advance of anticipated date of renal dialysis).

Timely elective peritoneal dialysis catheter insertion and Timely referral for renal transplantation.