ACE and obesity due to melanocortin 4 receptor deficiency: These strategies include the use of angiotensin-converting enzyme inhibitors (ACE) [18], angiotensin receptor blockers (ARB) [19] and diuretics [20]; the control of hypovolemia [21], obesity [22] and high blood pressure; the avoidance of nonsteroidal anti-inflammatory drugs, aminoglycosides and radiographic contrast agents [23]; the reduction of LVH [10]; a lower dose of dialysis [13]; the use of biocompatible dialysates and dialyzers and bicarbonate rather than acetate; and the early initiation of HD [5, 24, 25].