Verhave Jacobien C, Troyanov Stéphan, Mongeau Frédéric, Fradette Lorraine, Bouchard Josée, Awadalla Philip, Madore François
Division of Nephrology, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada, †Medical and Population Genomics Laboratory, University of Montréal, Montréal, Quebec, Canada.
Clin J Am Soc Nephrol. 2014 Apr;9(4):713-9. doi: 10.2215/CJN.06550613. Epub 2014 Jan 23.
It is uncertain how many patients with CKD and cardiovascular risk factors in publicly funded universal health care systems are aware of their disease and how to achieve their treatment targets.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The CARTaGENE study evaluated BP, lipid, and diabetes profiles as well as corresponding treatments in 20,004 random individuals between 40 and 69 years of age. Participants had free access to health care and were recruited from four regions within the province of Quebec, Canada in 2009 and 2010.
CKD (Chronic Kidney Disease Epidemiology Collaboration equation; <60 ml/min per 1.73 m(2)) was present in 4.0% of the respondents, and hypertension, diabetes, and hypercholesterolemia were reported by 25%, 7.4%, and 28% of participants, respectively. Self-awareness was low: 8% for CKD, 73% for diabetes, and 45% for hypercholesterolemia. Overall, 31% of patients with hypertension did not meet BP goals, and many received fewer antihypertensive drugs than appropriately controlled individuals; 41% of patients with diabetes failed to meet treatment targets. Among those patients with a moderate or high Framingham risk score, 53% of patients had LDL levels above the recommended levels, and many patients were not receiving a statin. Physician checkups were not associated with greater awareness but did increase the achievement of targets.
In this population with access to publicly funded health care, CKD and cardiovascular risk factors are common, and self-awareness of these conditions is low. Recommended targets were frequently not achieved, and treatments were less intensive in those patients who failed to reach goals. New strategies to enhance public awareness and reach guideline targets should be developed.
在公共资助的全民医疗保健系统中，患有慢性肾脏病（CKD）及心血管危险因素的患者中有多少人知晓自己的病情，以及如何实现治疗目标尚不确定。
设计、地点、参与者及测量方法：CARTaGENE研究评估了20004名年龄在40至69岁之间的随机个体的血压、血脂和糖尿病情况以及相应治疗。参与者可免费获得医疗保健服务，于2009年和2010年从加拿大魁北克省的四个地区招募。
4.0%的受访者存在CKD（慢性肾脏病流行病学协作组公式；<60 ml/min per 1.73 m²），分别有25%、7.4%和28%的参与者报告患有高血压、糖尿病和高胆固醇血症。自我知晓率较低：CKD为8%，糖尿病为73%，高胆固醇血症为45%。总体而言，31%的高血压患者未达到血压目标，且许多患者服用的降压药比血压得到适当控制的个体少；41%的糖尿病患者未达到治疗目标。在那些弗雷明汉风险评分中等或高的患者中，53%的患者低密度脂蛋白水平高于推荐水平，且许多患者未接受他汀类药物治疗。医生检查与更高的知晓率无关，但确实提高了目标达成率。
在这个可获得公共资助医疗保健的人群中，CKD和心血管危险因素很常见，且对这些情况的自我知晓率较低。推荐目标经常未达成，且未达到目标的患者治疗强度较低。应制定新策略以提高公众知晓率并达到指南目标。
