Meguid El Nahas A, Bello Aminu K
Sheffield Kidney Institute, Sheffield Teaching Hospital NHS Foundation Trust, Northern General Hospital Campus, University of Sheffield, Sheffield S5 7AU, UK.
Lancet. 2005;365(9456):331-40. doi: 10.1016/S0140-6736(05)17789-7.
The worldwide rise in the number of patients with chronic kidney disease (CKD) and consequent end-stage renal failure necessitating renal replacement therapy is threatening to reach epidemic proportions over the next decade, and only a small number of countries have robust economies able to meet the challenges posed. A change in global approach to CKD from treatment of end-stage renal disease (ESRD) to much more aggressive primary and secondary prevention is therefore imperative. In this Seminar, we examine the epidemiology of CKD worldwide, with emphasis on early detection and prevention, and the feasibility of methods for detection and primary prevention of CKD. We also review the risk factors and markers of progressive CKD. We explore current understanding of the mechanisms underlying renal scarring leading to ESRD to inform on current and future interventions as well as evidence relating to interventions to slow the progression of CKD. Finally, we make strategic recommendations based on future research to stem the worldwide growth of CKD. Consideration is given to health economics. A global and concerted approach to CKD must be adopted in both more and less developed countries to avoid a major catastrophe.
全球慢性肾脏病（CKD）患者数量不断增加，随之而来的是需要肾脏替代治疗的终末期肾衰竭患者数量也在上升，预计在未来十年内这一情况将达到流行程度，而只有少数几个国家拥有强大的经济实力来应对由此带来的挑战。因此，全球对慢性肾脏病的应对方式必须从终末期肾病（ESRD）的治疗转变为更积极的一级和二级预防。在本次研讨会上，我们研究了全球慢性肾脏病的流行病学，重点关注早期检测和预防，以及慢性肾脏病检测和一级预防方法的可行性。我们还回顾了慢性肾脏病进展的风险因素和标志物。我们探讨了目前对导致终末期肾衰竭的肾脏瘢痕形成机制的理解，以便为当前和未来的干预措施提供依据，以及与减缓慢性肾脏病进展的干预措施相关的证据。最后，我们根据未来研究提出战略建议，以遏制全球慢性肾脏病的增长。同时考虑了卫生经济学。无论是发达国家还是发展中国家，都必须采取全球一致的方法来应对慢性肾脏病，以避免一场重大灾难。
