Exploring new treatments for chronic kidney disease

To the Editor: We read with interest the excellent review by Turner et al. of both established and non-traditional treatment options for slowing progression of chronic kidney disease. The authors are to be commended for their consideration of novel applications of established therapies and metabolic targets not traditionally associated with treatments to slow disease progression. We wish to point out an omission in this report of a therapy with great promise. Pentoxifylline has been studied prospectively in more than 1000 patients enrolled in 19 clinical trials to date, with consistently positive results across disparate populations, without apparent toxicity, and with an excellent adverse-effect profile. Pentoxifylline is a non-specific phosphodiesterase inhibitor with renal anti-inflammatory, antioxidant, and anti-fibrotic activity. The drug targets a distinctly different pathophysiological mechanism of chronic kidney disease progression than that of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Pentoxifylline reduces proteinuria and preserves kidney function among patients with diabetic and non-diabetic chronic kidney disease, with or without concomitant inhibition of the renin–angiotensin axis, an important consideration given that a substantial proportion of diabetic patients either cannot tolerate or develop tachyphylaxis to such therapies. Health-care resources in the United States and globally will become increasingly constrained in the years to come; it is therefore essential that the nephrology community continues to explore new applications of existing therapies with demonstrated efficacy for slowing the progression of a disease that may impact X10% of the world’s adult population. We would be foolish to do otherwise.