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  • Review Article
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Emerging therapies for chronic kidney disease: what is their role?

Nature Reviews Nephrology volume 5, pages 375–383 (2009)Cite this article

Abstract

The prevalence of chronic kidney disease (CKD) is increasing worldwide. The best therapies currently available focus on the control of blood pressure and optimization of renin–angiotensin–aldosterone system blockade. Currently available agents are only partially effective against hard end points such as the development of end-stage renal disease and are not discussed in this Review. Many other agents have been shown to reduce proteinuria and delay progression in animal models of CKD. Some of these agents, including tranilast, sulodexide, thiazolidinediones, pentoxifylline, and inhibitors of advanced glycation end-products and protein kinase C, have been tested to a limited extent in humans. A small number of randomized controlled human trials of these agents have used surrogate markers such as proteinuria as end points rather than hard end points such as end-stage renal disease or doubling of serum creatinine level. Emerging therapies that specifically target and reverse pathological hallmarks of CKD such as inflammation, fibrosis and atrophy are needed to reduce the burden of this chronic disease and its associated morbidity. This Review examines the evidence for emerging pharmacological strategies for slowing the progression of CKD.

Key Points

  • Agents that block the renin–angiotensin–aldosterone system are the best of the currently available evidence-based therapies for slowing progression of chronic kidney disease (CKD), but are only partially effective

  • Many emerging therapies have shown promise in animal models of CKD, but have been less effective in humans

  • Regression of CKD in humans is rare

  • In the future, endothelin-receptor antagonists, agents that inhibit advanced glycation end-products and agents that reduce inflammation (for example, vitamin D and statins) might be useful in the treatment of human CKD

  • Experimental agents such as transforming growth factor β inhibitors, other growth factor inhibitors, small molecule inhibitors and cytokine inhibitors might also be useful in CKD in the future

  • All new therapies in CKD should be tested in conjunction with blockade of the renin–angiotensin–aldosterone system

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Figure 1: Kaplan–Meier curve showing the percentage of patients in the Reduction of Endpoints in NIDDM with Angiotensin II Receptor Antagonist Losartan (RENAAL) study reaching the end point of ESRD.

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    Eswari Vilayur & David C. H. Harris

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Vilayur, E., Harris, D. Emerging therapies for chronic kidney disease: what is their role?. Nat Rev Nephrol 5, 375–383 (2009). https://doi.org/10.1038/nrneph.2009.76

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