Can we prolong life of patients with advanced chronic kidney disease: what is the clinical evidence?

The risk of death in patients with advanced chronic kidney disease (CKD) is markedly higher than in the population without CKD, even in patients suffering from advanced cardiovascular disease. Among several clinical features of CKD, the following are considered the most important areas of therapeutic intervention: hypertension, lipid abnormalities, mineral and bone disorders of CKD (previously known as renal osteodystrophy), renal anemia, and uremic toxicity. However, numerous treatment strategies, which are applied based on the understanding of underlying pathologies, did not result in significantly improved prognosis. These strategies include lowering of blood pressure, use of statins, control of hyperphosphatemia and hyperparathyroidism, erythropoesis-stimulating agents, use of better and more biocompatible dialysis membranes, and higher dialysis dose. In this critical review, we discuss the most important, large clinical trials, in which the above therapies failed to show desirable results and to reduce mortality in patients with advanced CKD.