Biochemical risk markers: a novel area for better prediction of renal risk?

Prevention of end-stage renal disease (ESRD) by early detection and treatment is an important tool to stop the growing need for renal replacement therapy. The last decade has brought forward strong reasons for such an approach. The incidence of ESRD has increased dramatically, which is mostly attributed to type 2 diabetes [1] and improved survival from atherosclerotic vascular disease [2]. This increased rate of ESRD further augments the already high burden on the patient and doctor, as well as on health care economics. Indeed, patients entering a renal replacement programme are 15 times more likely to die relative to subjects in the general population. The target population for prevention still needs to be defined. There is no doubt that prevention in patients with glomerulonephritis, pyeloand interstitial nephritis and diabetic renal disease is feasible. For non-diabetic subjects, logical steps are to identify those who are also at risk for the consequences of progressive renal disease, such as subjects with (undiagnosed) slight renal dysfunction. Only recently, the high prevalence ( 10%) of mild to moderate renal insufficiency [glomerular filtration rate (GFR) 30 kg/m] were at high risk for developing proteinuria and loss of renal function after unilateral nephrectomy compared with lean subjects [15]. Smoking has also been demonstrated to be a risk factor for progressive renal function loss. Epidemiological data reveal that smoking has deleterious effects on the kidney in Correspondence and offprint requests to: D. de Zeeuw, MD PhD, Professor and Head, Department of Clinical Pharmacology, UniversityMedicalCenter,Ant.Deusinglaan1, 9713AV,POBox196, Groningen, The Netherlands. Email: d.de.zeeuw@med.rug.nl