MANAGING CHRONIC RENAL INSUFFICIENCY: MANAGEMENT OF COMORBID PROBLEMS
Cardiovascular disease accounts for about 50% of all deaths in ESRD. This mortality is attributed in part to risks during progressive renal insufficiency. Modifiable risk factors such as smoking, obesity, and insufficient physical inactivity should be addressed and corrected, if possible.
Depression, a common consequence of chronic illness, should be determined and treated. Pharmacologic treatment is similar to that in normal renal function since dose adjustment is not required for most commonly used antidepressants.
Sexual Dysfunction and Pregnancy
The precise incidence of impaired libido, erectile dysfunction, and infertility in azotemic subjects is unknown, but complaints of sexual malfunction magnify as renal failure progresses. Hyperprolactinemia, vascular insufficiency, autonomic neuropathy and some antihypertensive medications may also cause impotence.
Contraception is advised in patients of child-bearing age who do not wish to conceive. Condoms, diaphragms, and absent contraindications, oral contraceptives may be used. Intrauterine devices should be avoided because of risk of bleeding.
Azotemic patients who wish to get pregnant should be advised that there is an increased risk of de novo or worsening hypertension. Also, there may be decreased renal function (as much as 20% decline in renal function), and about 50% of those with glomerular disease will have an increase in proteinuria. While these changes generally resolve after delivery, perinatal mortality (still births and neonatal deaths) is about three times (6%) the rate in persons with normal renal function.
Acquired Immunodeficiency Syndrome (AIDS)
HIV disease is becoming an increasing caus chronic renal failure, especially among African
Americans. Possibly due to general improvements in the management of AIDS, survival on hemodialysis of patients with ESRD and HIV infection has improved substantially compared with the dismal outcomes reported in the 1980s. online canadian pharmacy
Single center and uncontrolled studies suggest that treatment with ACE inhibitors or antiretroviral drugs may retard progression of renal failure in persons with HIV-associated nephropathy.
Renal impairment compels dose adjustments, but not saquinavir.