Hallan Stein Ivar, Vikse Bjørn Egil
Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Curr Opin Nephrol Hypertens. 2008 May;17(3):286-91. doi: 10.1097/MNH.0b013e3282f8b177.
Incidence of end-stage renal disease has increased dramatically during the last 30 years and screening for early stages of chronic kidney disease is often suggested as a preventive measure. The relationship between chronic kidney disease and end-stage renal disease is complex, however, and recent studies have given some insights into this relationship. The review will summarize these studies and briefly discuss the clinical implications.
While the prevalence of chronic kidney disease is high in most Western countries, the incidence of end-stage renal disease differs substantially. The general increase in the incidence of end-stage renal disease seen in recent years may be partially explained by a lower cardiovascular mortality, allowing more patients with chronic kidney disease to develop end-stage renal disease, and widening of entrance criteria for renal replacement therapy. Data do not, however, support these factors as explanatory for the existing international differences. These differences are better explained by different prevalences of diabetes and obesity as well as by differences in rate of progression from early chronic kidney disease stages to end-stage renal disease. Rate of progression seems to be affected by race, socioeconomic status and predialytic care.
Several mechanisms influence the relationship between chronic kidney disease and risk of end-stage renal disease. Decreased cardiovascular mortality and improved treatment availability may explain parts of the increase in the incidence of end-stage renal disease, and there are also large international differences in rates of progression from chronic kidney disease to end-stage renal disease that may be amendable by public health and predialytic care interventions.
在过去30年中，终末期肾病的发病率急剧上升，慢性肾病早期筛查常被视为一项预防措施。然而，慢性肾病与终末期肾病之间的关系很复杂，近期研究对这种关系有了一些深入了解。本综述将总结这些研究，并简要讨论其临床意义。
虽然大多数西方国家慢性肾病的患病率很高，但终末期肾病的发病率差异很大。近年来终末期肾病发病率的普遍上升，部分原因可能是心血管死亡率降低，使得更多慢性肾病患者发展为终末期肾病，以及肾脏替代治疗的准入标准放宽。然而，现有数据并不支持这些因素能够解释目前存在的国际差异。这些差异更好的解释是糖尿病和肥胖的患病率不同，以及从慢性肾病早期阶段发展到终末期肾病的进展速度差异。进展速度似乎受种族、社会经济地位和透析前护理的影响。
多种机制影响慢性肾病与终末期肾病风险之间的关系。心血管死亡率降低和治疗可及性提高，可能部分解释了终末期肾病发病率的上升，而且从慢性肾病到终末期肾病的进展速度在国际上也存在很大差异，这可能可通过公共卫生和透析前护理干预加以改善。
