अमूर्त

Kidney: Nephrology and therapeutics

Michael F Michelis

Patients with the advanced renal disease have become more complicated and factors such as complex associated conditions, aging, increasing numbers of available pharmacologic agents and improvement in renal replacement therapies have made decision making more challenging. Subjects evaluated include proper approaches to blood pressure therapy in patients with pre, inter or intra dialysis blood pressure abnormalities. Medication characteristics outlined and the effects of various drugs as they relate to the dialysis procedure have been described. Also, metabolic issues such as approaches to hyperuricemia and metabolic acidosis have been reviewed and discussed. New agents and their benefits and limitations noted and present goals of therapy reviewed. Furthermore, the effects of increased body mass and glucose intolerance on survival, as well as possible corrective measures, elucidated. New approaches to glucose control and current blood pressure goals will be discussed. Finally, current approaches to renal replacement therapy will be reviewed and the importance of the timing of interventions and the choice of access and modality will receive consideration. These issues apply particularly to patients of advanced age. Factors influencing such decisions will be presented and critically evaluated.