Division of Community Health Sciences, HunterWing, St George's, University of London, London SW17 0RE.
Br J Gen Pract. 2010 Jun;60(575):e258-65. doi: 10.3399/bjgp10X502164.
Chronic kidney disease (CKD) is a relatively recently recognised condition. People with CKD are much more likely to suffer from cardiovascular events than progress to established renal failure. Controlling systolic blood pressure should slow the progression of disease and reduce mortality and morbidity. However, no systematic review has been conducted to explore the effectiveness of quality-improvement interventions to lower blood pressure in people with CKD.
To assess the effectiveness of quality-improvement interventions to reduce systolic blood pressure in people with CKD in primary care, in order to reduce cardiovascular risk and slow the progression of renal disease.
Papers were identified from the trial data bases of the Cochrane Effective Practice and Organisation of Care Group (EPOC) and Cochrane renal groups. In a three-round process, at least two investigators read the papers independently. Studies were initially excluded based on their abstracts, if these were not relevant to primary care. Next, full papers were read, and again excluded on relevance. Quantitative and, where this was not possible, qualitative analyses of the findings were performed.
The selected studies were usually carried out on high-risk populations including ethnic minorities. The interventions were most often led by nurses or pharmacists. Three randomised trials showed a combined effect of a reduction in systolic blood pressure of 10.50 mmHg (95% confidence interval [CI] = 5.34 to 18.41 mmHg). One non-randomised study showed a reduction in systolic blood pressure of 9.30 mmHg (95% CI = 3.01 to 15.58 mmHg).
Quality-improvement interventions can be effective in lowing blood pressure, and potentially in reducing cardiovascular risk and slowing progression in CKD. Trials are needed in low-risk populations to see if the same improvements can be achieved.
慢性肾脏病（CKD）是一种相对较新的疾病。患有 CKD 的人患心血管事件的风险比进展为终末期肾衰竭的风险更高。控制收缩压应能减缓疾病的进展并降低死亡率和发病率。然而，目前还没有系统的综述来探讨改善质量的干预措施对降低 CKD 患者血压的有效性。
评估改善质量的干预措施对降低 CKD 患者收缩压的有效性，以降低心血管风险并减缓肾脏疾病的进展。
从 Cochrane 有效实践和组织护理组（EPOC）和 Cochrane 肾脏组的试验数据库中确定了论文。在三轮过程中，至少两名研究人员独立阅读论文。如果摘要与初级保健无关，则最初根据摘要排除研究。然后，阅读全文，并根据相关性再次排除。对发现进行定量和（如果不可能，则进行定性）分析。
所选研究通常针对包括少数民族在内的高危人群进行。干预措施通常由护士或药剂师主导。三项随机试验显示收缩压降低了 10.50mmHg（95%置信区间[CI]=5.34 至 18.41mmHg）。一项非随机研究显示收缩压降低了 9.30mmHg（95%CI=3.01 至 15.58mmHg）。
质量改进干预措施可以有效降低血压，并可能降低 CKD 的心血管风险和减缓进展。需要在低风险人群中进行试验，以了解是否可以实现相同的改善。
