St Peter Wendy L
College of Pharmacy at the University of Minnesota, Minneapolis, MN 55404, USA.
J Manag Care Pharm. 2007 Dec;13(9 Suppl D):S2-5. doi: 10.18553/jmcp.2007.13.9-d.2.
The kidneys function as excretory, biosynthetic, and metabolic organs, vital for maintaining normal physiology. Although dialysis can replace some kidney functions, it cannot replicate the biosynthetic and metabolic activities of the normal kidney. Chronic kidney disease (CKD) and its terminal complication, end-stage renal disease (ESRD), may progress undetected until immediately before symptomatic kidney failure develops. At this point in the disease process, few opportunities exist to prevent adverse outcomes.
To (1) review the incidence, prevalence, and staging of CKD and ESRD and (2) elucidate that the management of CKD is suboptimal and costly.
CKD is defined according to the presence or absence of kidney damage and level of kidney function. The Kidney Disease Outcomes Quality Initiative designates 5 stages of CKD, with stage 5 being ESRD -- the point at which patients' loss of kidney function precipitates a need for dialysis or kidney transplant. The United States Renal Data System has documented monumental growth of the ESRD population and its significant impact on Medicare and its budget. In 2005, approximately 1.2% of Medicare's 31 million beneficiaries who had ESRD generated 6.4% of Medicare's total costs. One of the most important aspects of CKD diagnosis and treatment is early detection and aggressive management of underlying causes. However, care for CKD patients is fragmented. Primary care physicians, cardiovascular specialists, endocrinologists, dietitians, and pharmacists may be engaged in the patient's care early but the nephrologist may not be approached until late, if at all.
CKD is costly. Preventing progression to ESRD may improve quality of life and help save health care dollars. A concerted approach to manage CKD patients effectively starts with early detection and integrated management by multiple specialties. Delaying disease progression is crucial and must include patient education and aggressive treatment and management of CKD and its comorbidities. Interdisciplinary care models in which pharmacists are integrally involved should be replicated.
肾脏作为排泄、生物合成和代谢器官，对维持正常生理功能至关重要。尽管透析可以替代部分肾脏功能，但它无法复制正常肾脏的生物合成和代谢活动。慢性肾脏病（CKD）及其终末期并发症——终末期肾病（ESRD），在有症状的肾衰竭发生之前可能未被察觉地进展。在疾病发展到这一阶段时，预防不良后果的机会很少。
（1）回顾CKD和ESRD的发病率、患病率及分期；（2）阐明CKD的管理存在不足且成本高昂。
CKD根据是否存在肾脏损伤及肾功能水平来定义。肾脏病预后质量倡议组织将CKD分为5期，5期即ESRD——此时患者肾功能丧失促使其需要透析或肾移植。美国肾脏数据系统记录了ESRD患者数量的巨大增长及其对医疗保险及其预算的重大影响。2005年，医疗保险的3100万受益人中约1.2%患有ESRD，产生了医疗保险总成本的6.4%。CKD诊断和治疗最重要的方面之一是早期发现并积极处理潜在病因。然而，对CKD患者的护理是分散的。初级保健医生、心血管专科医生、内分泌科医生、营养师和药剂师可能在早期就参与患者护理，但肾病科医生可能很晚才介入，甚至根本不会参与。
CKD成本高昂。预防进展到ESRD可能改善生活质量并有助于节省医疗费用。有效管理CKD患者的协同方法始于早期发现并由多个专科进行综合管理。延缓疾病进展至关重要，必须包括患者教育以及对CKD及其合并症的积极治疗和管理。应推广药剂师全面参与的跨学科护理模式。
