Treatment options

The treatment of patients with CKD includes the following aspects:

1. Identification of acute signs and treatable causes of CRF;
2. Prevent or slow down the progression of CRF: Change of diet, control of hypertension, hyperlipidemia, calcium-phosphorus metabolism and hyperglycaemia;
3. Symptomatic treatment of complications: cardiovascular, water and sodium metabolic disorders, hyperkalemia, metabolic acidosis, pruritus, hyperuricemia, anaemia, impaired haemostasis, hypermagnesaemia, gastrointestinal and neuromuscular symptoms. 

At CKD stage 5, with eGFR between 5 and 10 ml/min/1.73 m², the initiation of a maintenance dialysis programme or kidney transplantation is suggested based on individual assessment in order to balance the decision in clinical practice with the patients' wishes and desires, their values, cultural backgrounds and the patients' views on quality of life and risks they may want to take, unless clinical conditions indicate earlier initiation.

The choice between transplantation, haemodialysis or peritoneal dialysis depends on the personal choices of the patient, and his clinical situation as evaluated by the responsible doctor. No difference in survival exists between the two therapies.

As part of our philosophy and social commitment, we at NephroCare have the responsibility to always opt for the patient´s best possible care and treatment modality. Therefore, we always advocate for a transplantation programme, whenever the specific patient´s disease status, choice of treatment and options given by the healthcare systems allow it.

All CKD patients are candidates for transplantation, except in the presence of:

• an active infectious disease.
• a severe chronic, irreversible and extrarenal pathology: advanced dementia, severe liver disease, generalised atherosclerosis ...
• an active neoplasm. All patients with a history of cancer should be assessed individually, it being necessary in some cases to establish a safety period between graft placement and tumour resolution.

Vascular access is frequently referred to as the ‘patient lifeline’. Given the vital importance of this topic NephroCare has developed numerous tools and services focusing on the management and care of vascular access. More than a decade of experience in our NephroCare clinics has given us a high level of renal care expertise which we constantly reinvest in the NephroCare network in the form of guidelines and best practice approaches enriched and guided by NephroCare Coordination services and tools.

For more information, please read our chapter about Vascular Access Management

Despite significant improvements in the quality and efficacy of haemodialysis therapy in recent years, cardiovascular disease (CVD) remains the leading cause of death for dialysis patients. Today, almost every other dialysis patient dies from cardiovascular complications. NephroCare is supporting nephrologists worldwide in reducing their patients’ risks for cardiovascular morbidity and mortality.

Moreover, one of our major goals for the coming years is the development and implementation of innovative new therapies and products that further improve the cardiovascular prognosis of dialysis patients.

For more information, please read our chapter about Haemodialysis therapies