Fox Chester H, Voleti Vasu, Khan Linda S, Murray Brian, Vassalotti Joseph
University of Buffalo, Buffalo, NY, USA.
Postgrad Med. 2008 Jul 31;120(2):E01-6. doi: 10.3810/pgm.2008.07.1798.
With the aging of the US population and the increase in hypertension, diabetes mellitus, and obesity, the prevalence of chronic kidney disease (CKD) is increasing in the United States. Its prevalence rate has risen to 13.1% of the US population. Patients with CKD experience poor outcomes and have high health care costs. Chronic kidney disease is also a major cardiovascular disease risk factor. In fact, most people with CKD die of heart disease before they progress to end-stage renal disease. The National Kidney Foundation has produced evidence-based guidelines known as the Kidney Disease Outcomes Quality Initiative (KDOQI). These guidelines outline many things that the primary care physician can do to delay the progression of CKD, and to arrange for early referral for the prevention of future complications. However, there is limited knowledge and uptake of these guidelines because of their length and and complexity. Patients with CKD risk factors, hypertension, diabetes mellitus, cardiovascular disease, a family history of CKD, and those older than 60 years should be screened using 2 tests: 1) the estimated glomerular filtration rate and 2) the urinary albumin-creatinine ratio. These tests allow the diagnosis and stratification of CKD into 5 stages. This article synthesizes the key evidence-based behaviors and clinical action plan that primary care physicians can implement to treat CKD and its complications.
随着美国人口老龄化以及高血压、糖尿病和肥胖症发病率的上升，美国慢性肾脏病（CKD）的患病率正在增加。其患病率已升至美国人口的13.1%。CKD患者预后较差，医疗成本高昂。慢性肾脏病也是主要的心血管疾病危险因素。事实上，大多数CKD患者在进展到终末期肾病之前死于心脏病。美国国家肾脏基金会制定了基于证据的指南，即《肾脏病预后质量倡议》（KDOQI）。这些指南概述了初级保健医生可以采取的许多措施，以延缓CKD的进展，并安排早期转诊以预防未来并发症。然而，由于这些指南篇幅长且复杂，人们对其了解和采用程度有限。具有CKD危险因素、高血压、糖尿病、心血管疾病、CKD家族史的患者以及60岁以上的患者应使用两项检查进行筛查：1）估计肾小球滤过率和2）尿白蛋白肌酐比值。这些检查可对CKD进行诊断并分层为5个阶段。本文综合了初级保健医生可用于治疗CKD及其并发症的关键循证行为和临床行动计划。
