Munikrishnappa Devaraj
Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri 63104, USA.
Aging Male. 2007 Sep;10(3):113-37. doi: 10.1080/13685530701419096.
Chronic kidney disease (CKD) is becoming increasingly prevalent among many different populations all over the world, including the US and Europe. Its multitude of complications with devastating outcomes leads to a significantly higher risk for cardio-vascular and all-cause mortality in an individual. However, it is clear now that early detection of CKD might not only delay some of the complications but also prevent them. Therefore, various important public health organizations all over the world have turned their focus and attention to CKD and its risk factors, early detection and early intervention. Nevertheless, the general goals in preventing the increase in CKD and its complications are far from being completely achieved. Why is this so? What is the magnitude and complexity of the problem? How is it affecting the population - are there differences in its affection by age, gender or frail elderly versus the robust? Are we modifying the risk factors appropriately and aggressively? Are there subtle differences in managing the risk factors in those on dialysis versus the non-dialysis CKD patients? Is it important to treat anaemia of CKD aggressively, will it make a difference in the disease progression, its complications or to quality of life? What do these unfortunate individuals commonly succumb to? What do we advise patients who refuse dialysis or those who desire dialysis or transplant? Are there useful non-dialytic treatment recommendations for those who refuse dialysis? What is the role of the physicians caring for the elderly with CKD? When should the primary care givers refer a CKD patient to a nephrologist? The key to eventually controlling incident and prevalent CKD and improve quality of life of affected individuals, lies in not only knowing these and many other vital aspects, but also in applying such knowledge compulsively in day-to-day practice by each and every one us. As CKD is increasingly a disease of the elderly with men being affected more, this review details fairly comprehensively the vital aspects of CKD, especially from a primary care geriatrician's practical standpoint.
慢性肾脏病（CKD）在包括美国和欧洲在内的全球许多不同人群中日益普遍。其众多具有毁灭性后果的并发症导致个体发生心血管疾病和全因死亡的风险显著升高。然而，现在很清楚的是，早期发现CKD不仅可能延缓一些并发症的发生，还能预防这些并发症。因此，世界各地的各种重要公共卫生组织都将重点和注意力转向了CKD及其危险因素、早期发现和早期干预。尽管如此，预防CKD增加及其并发症的总体目标远未完全实现。为什么会这样呢？问题的严重程度和复杂性如何？它如何影响人群——在年龄、性别或体弱老年人与健康人群之间的影响是否存在差异？我们是否正在适当地、积极地改变危险因素？在透析患者与非透析CKD患者中，管理危险因素是否存在细微差异？积极治疗CKD贫血是否重要，这会对疾病进展、其并发症或生活质量产生影响吗？这些不幸的个体通常死于什么？对于拒绝透析或渴望透析或移植的患者，我们该如何建议？对于拒绝透析的患者，是否有有用的非透析治疗建议？照顾CKD老年人的医生的作用是什么？初级保健提供者应何时将CKD患者转诊给肾病专家？最终控制CKD的发病率和患病率并改善受影响个体生活质量的关键，不仅在于了解这些以及许多其他重要方面，还在于我们每个人在日常实践中强制应用这些知识。由于CKD越来越成为一种老年疾病，男性受影响更多，本综述相当全面地详细介绍了CKD的重要方面，特别是从初级保健老年医学专家的实际角度。
