End stage renal disease (ESRD) is epidemic worldwide and it imposes substantial patient morbidity and mortality and consumes a large portion of the healthcare expenditure of a society [1]. The International Society of Nephrology (ISN) 2004 Consensus Workshop on Prevention of Progression of Renal Disease was held in Hong Kong on June 29, 2004. Three key areas were discussed during the Workshop: (i). Screening for chronic kidney disease; (ii). Evaluation and estimating progression of chronic kidney disease; and (iii). Measures to prevent the progression of chronic kidney disease. Fifteen Consensus Statements were made in these 3 areas as endorsed by the participants of the Workshop [2]. An effective screening program makes use of acceptable tests that can accurately and reliably detect relatively asymptomatic disease at an early stage. Ideally this will allow an effective treatment, resulting in improved outcomes when compared with an unscreened population. Its value increases if there is a significant prevalence of the disease in the population, and a considerable proportion of the target population has preclinical or asymptomatic disease. This has prompted the development of strategies aimed at preventing the development and progression of asymptomatic chronic kidney disease (CKD). Community strategies to reduce the incidence of ESRD integrate methods of screening and early intervention. Issues surrounding the screening of CKD include (i) whom to screen; (ii) how to screen; and (iii) what to do when screening shows an abnormality. Our recent Consensus Statements recommended that patients diagnosed with diabetes and hypertension should have regular screening for development of kidney disease [2]. We also recommend that close relatives of patients with nephropathy due to diabetes, hypertension and glomerulonephritis should also be the primary targets for screening to detect clinically silent kidney disease. In addition, subjects over the age of 60 to 65 years are also at risk for unrecognized CKD [3]. There is, however, no consensus on the exact age ﾒcut-offﾓ for initiating CKD screening. Both our Consensus Statements [2] and the recent Kidney Disease Improving Global Outcome (KDIGO) Position Statements [4] endorsed albuminuria as a marker of kidney damage. Our Consensus Statements also recommended to validate the current GFR estimation formulas based on ethnicities in different parts of the world [2]. Diabetes, glomerulonephritis and hypertension are the 3 most common causes for the new cases of renal failure in most parts of the world. Effective therapeutic measures are now available which might prevent the progression of CKD [2]. These measures include: (i) life style modification; (ii) blood pressure control; (iii) glycemic control; (iv) reduction of proteinuria; (v) protein restriction; (vi) lipid lowering; (vii) avoidance of nephrotoxic agents; (viii) early referral to nephrologists and (ix) others measures (e.g. correction of anemia). The beneficial use of ACE inhibitor and Angiotensin receptor blockers [5] in different stages of renal failure are recognized. Chronic kidney disease (CKD) not only reflects target organ injury in
systemic vascular disease in the general population and in association
with diabetes, hypertension, and smoking, but it is recognized as one
of the major risk factors in the pathogenesis and outcome of cardiovascular
disease [2]. In addition to detection and treatment of high BP, patients
with CKD should be assessed for all cardiovascular risk factors. Physicians
treating patients with both kidney disease and CVD should fully appreciate
their exceptionally high-risk status [2]. References:
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