Progress in retarding the progression of advanced chronic kidney disease: Grounds for optimism

It has been generally held that once glomerular filtration rate (GFR) falls below approximately 25 ml/min, a relentless progression to end-stage renal disease (ESRD) inevitably ensues, regardless of the original cause of reduced function. There is a paucity of contemporary studies, however, addressing whether the rate of progression can be slowed down with contemporary and comprehensive renal care when chronic kidney disease (CKD) has progressed to stages 4 and 5 (GFR < 30 ml/min/1.73 m(2)). In this review we argue that significant progress is being made already in retarding the progression of advanced CKD thereby delaying the initiation of renal replacement therapy. We propose that CKD clinics, by providing comprehensive management of CKD, will have a decisive role in preventing and delaying the progression to advanced CKD.