Maione Ausilia, Strippoli Giovanni F M
Mario Negri Sud Consortium, S. Maria Imbaro (Ch), Italy.
Ethn Dis. 2009 Spring;19(1 Suppl 1):S1-86-9.
Chronic kidney disease is becoming a public health challenge due to the high risk of progression to end-stage kidney disease, the increased cardiovascular burden and management costs, especially among disadvantaged communities. Although the high prevalence of hypertension and diabetes in these populations are recognized risk factors and a leading cause of chronic kidney disease, ethnic populations show a greater likelihood of developing end-stage kidney disease regardless of these cardiovascular risk factors. The association between low socioeconomic status and the prevalence/progression of chronic kidney disease observed in population-based studies suggests that socioeconomic disadvantage could be a plausible reason for the increased burden of renal disease among minorities. Interventions for management and prevention of chronic kidney disease include angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Few studies of these agents have been conducted in indigenous populations, but there is evidence that angiotensin converting enzyme inhibitors are effective in reducing premature deaths and progression of chronic kidney disease, as well as being highly cost-effective, especially in terms of renal replacement therapies avoided. It is plausible that these disadvantaged groups may benefit more than others from a renal and cardiovascular prevention program, but considerable under-recognition and under-treatment of these conditions still exist.
慢性肾脏病正成为一项公共卫生挑战，这是因为其进展为终末期肾病的风险很高，心血管负担和管理成本不断增加，在弱势群体中尤为如此。尽管这些人群中高血压和糖尿病的高患病率是公认的风险因素以及慢性肾脏病的主要病因，但无论这些心血管风险因素如何，少数族裔人群发生终末期肾病的可能性更大。在基于人群的研究中观察到的社会经济地位低下与慢性肾脏病患病率/进展之间的关联表明，社会经济劣势可能是少数族裔中肾脏疾病负担增加的一个合理原因。慢性肾脏病的管理和预防干预措施包括血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂。针对这些药物在原住民中的研究很少，但有证据表明血管紧张素转换酶抑制剂在降低过早死亡和慢性肾脏病进展方面有效，而且具有很高的成本效益，特别是在避免肾脏替代治疗方面。这些弱势群体可能比其他群体从肾脏和心血管预防计划中获益更多，这似乎是合理的，但对这些疾病的认识不足和治疗不足的情况仍然相当严重。
