日本透析医学会 学術集会・総会 抄録アーカイブ MICEnavi

Value-based kidney-care models have started as of 2022 in the USA and include incentives to delay dialysis initiation in persons with Chronic kidney disease (CKD). Preservation of kidney function can improve outcomes and can be achieved through non-pharmacological strategies (e.g., dietary and lifestyle adjustments) and CKD-targeted and kidney disease-specific pharmacological interventions. A plant-dominant, low-protein, and low-salt diet. Known as PLADO diet, might help to mitigate glomerular hyperfiltration and preserve renal function for longer, possibly while also leading to favorable alterations in acid-base homoeostasis and in the gut microbiome. Pharmacotherapies that alter intrarenal hemodynamics (e.g., renin-angiotensin-aldosterone pathway modulators and SGLT2 inhibitors) can preserve kidney function by reducing intraglomerular pressure independently of blood pressure and glucose control, whereas other novel agents (e.g., non-steroidal mineralocorticoid receptor antagonists) might protect the kidney through anti-inflammatory or antifibrotic mechanisms. Keto-analogues supplement low to very low protein diets (sVLPD) under PLADO may help with far-advanced CKD (eGFR <30 ml/min). CKD-associated cardiovascular risk, minimizing the risk of infection, and preventing acute kidney injury are crucial interventions for these patients, given the high burden of complications, associated morbidity and mortality, and the role of non-conventional risk factors in chronic kidney disease. When renal replacement therapy becomes inevitable, an incremental transition to dialysis can be considered and has been proposed to possibly preserve residual kidney function longer. There are similarities and distinctions between kidney-preserving care and supportive care. Additional studies of dietary and pharmacological interventions and development of innovative strategies are necessary to ensure optimal kidney-preserving care and to achieve greater longevity and better quality of life to delay dialysis initiation. When dialysis is needed, an incremental dialysis transition is preferred in the form of once to twice-weekly hemodialysis or sporadic peritoneal dialysis.

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