Almaguer Miguel, Herrera Raúl, Alfonso Jorge, Magrans Charles, Mañalich Reynaldo, Martínez Atilano
Instituto de Nefrologia, Ave 26 y Boyeros, Plaza, Havana City, Cuba.
Kidney Int Suppl. 2005 Aug(97):S4-10. doi: 10.1111/j.1523-1755.2005.09701.x.
End-stage renal disease (ESRD) is a major health problem in the world, including Cuba. There is an increasing trend in both the incidence and prevalence of ESRD. Global projections consistently show an increase of patients in maintenance dialysis, and also an epidemic trend in diabetes mellitus and hypertension, two diseases that are leading causes of ESRD in most countries. A new paradigm is necessary to handle this major health problem, such as a public health model that integrates health promotion and disease prevention. In 1996, the Ministry of Public Health of Cuba launched a national program for the prevention of chronic renal failure (CRF). The progressive implementation of this program follows several steps: the analysis of the resources and health situation in the country; epidemiological research to define the burden of CRF; continuing education for nephrologists, family doctors, and other health professionals; and reorientation of primary health care toward increased nephrology services, intervention, and surveillance. The main outcomes of the program have been: a rational redistribution of nephrology services in corresponding health areas of primary health care; nephrologists being brought closer to the community; an improvement in the knowledge and ability of family doctors and nephrologists in the prevention of chronic renal disease; an increase in the number of patients with CRF (serum creatinine > or = 133 micromol/L or > or = 1.5 mg/dL, or a glomerular filtration rate < 60 mL/min) who are registered in primary health care every year, from a prevalence of 0.59 per 1,000 inhabitants at the beginning of the program in 1996 to 0.92 per 1,000 inhabitants in 2002, with a mean prevalence growth of 9.2% per year; a significant reduction (0.1%) in the incidence of viral hepatitis B in dialysis patients after the implementation of vaccination against viral hepatitis B in CRF patients who are registered in primary health care; and the implementation of CRF surveillance in primary health care, which provides periodic information on CRF burden, patterns, and trends to assist evidence-based public-health decision making, and measures the impact of interventions in the population. Primary health care is an essential tool, and the community is an appropriate social space for health promotion and the prevention of CRF and ESRD.
终末期肾病（ESRD）是包括古巴在内的全球主要健康问题。ESRD的发病率和患病率呈上升趋势。全球预测一致显示维持性透析患者数量增加，糖尿病和高血压也呈流行趋势，这两种疾病是大多数国家ESRD的主要病因。需要一种新的模式来应对这一主要健康问题，例如整合健康促进和疾病预防的公共卫生模式。1996年，古巴公共卫生部启动了一项预防慢性肾衰竭（CRF）的国家计划。该计划的逐步实施包括以下几个步骤：分析该国的资源和健康状况；进行流行病学研究以确定CRF的负担；对肾病学家、家庭医生和其他卫生专业人员进行继续教育；以及将初级卫生保健重新定位为增加肾病服务、干预和监测。该计划的主要成果包括：在初级卫生保健的相应健康领域合理重新分配肾病服务；使肾病学家更接近社区；提高家庭医生和肾病学家预防慢性肾病的知识和能力；每年在初级卫生保健中登记的CRF患者（血清肌酐≥133微摩尔/升或≥1.5毫克/分升，或肾小球滤过率<60毫升/分钟）数量增加，从1996年该计划开始时每1000名居民中的患病率0.59上升到2002年的每1000名居民中的患病率0.92，平均每年患病率增长9.2%；在初级卫生保健中登记的CRF患者接种乙肝疫苗后，透析患者中乙肝病毒感染率显著降低（0.1%）；以及在初级卫生保健中实施CRF监测，提供有关CRF负担、模式和趋势的定期信息，以协助基于证据的公共卫生决策，并衡量干预措施对人群的影响。初级卫生保健是一项重要工具，社区是促进健康以及预防CRF和ESRD的合适社会空间。
