Rout Preeti, Aslam Ahsan
Wilson Case Western University
Indiana University School of Medicine, IU Health
More than 500,000 people in the United States (US) live with end-stage renal disease (ESRD). The development of chronic kidney disease (CKD) and its progression to ESRD remains a significant cause of reduced quality of life and premature mortality. CKD is a debilitating disease, and standards of medical care involve aggressive monitoring for signs of disease progression and early referral to specialists for dialysis or possible renal transplant. The Kidney Disease Improving Global Outcomes (KDIGO) foundation guidelines define CKD using kidney damage markers, specifically those that determine proteinuria and glomerular filtration rate (GFR). By definition, the presence of both factors (GFR <60 mL/min and albumin >30 mg/g of creatinine) along with abnormalities of kidney structure or function for greater than three months signifies chronic kidney disease. ESRD is defined as a GFR of less than 15 mL/min. According to KDIGO 2012 clinical practice guideline, CKD is classified into the following 6 stages based on the GFR level: Stage 1: Kidney damage with normal GFR (>90 mL/min) but other abnormalities in urine production. Stage 2: Mild reduction in GFR (60-89 mL/min). Stage 3a: Moderate reduction in GFR (45-59 mL/min). Stage 3b: Moderate reduction in GFR (30-44 mL/min). Stage 4: Severe reduction in GFR (15-29 mL/min). Stage 5: Renal failure (GFR <15 mL/min). In the US, in 2008, over 100,000 patients were initiated on dialysis; of those, 44% had received no predialysis care, which may have contributed to the observed high mortality within the first 3 months of dialysis initiation. Most patients in the US are treated with in-center dialysis. They are not offered alternative forms of renal replacement, such as home dialysis, peritoneal dialysis, or pre-emptive kidney transplant. Providing education on alternative forms of renal replacement is crucial, as it enables the establishment of permanent access to the dialysis method of choice. Study results indicate a low rate of renal replacement therapy, excluding in-center dialysis, despite no contraindications, primarily due to a lack of patient education and preparation.
美国有超过50万人患有终末期肾病（ESRD）。慢性肾病（CKD）的发展及其向这种终末期疾病的进展仍然是生活质量下降和过早死亡的一个重要原因。慢性肾病（CKD）是一种使人衰弱的疾病，医疗护理标准包括积极监测疾病进展迹象，并尽早转诊给专科医生进行透析或可能的肾移植。改善全球肾脏病预后（KDIGO）基金会指南使用肾脏损伤标志物来定义CKD，特别是那些确定蛋白尿和肾小球滤过率的标志物。根据定义，同时存在这两个因素（肾小球滤过率[GFR]低于60 mL/分钟和白蛋白大于每克肌酐30毫克）以及肾脏结构或功能异常超过三个月，即意味着患有慢性肾病。终末期肾病的定义是GFR低于15 mL/分钟。根据KDIGO 2012临床实践指南，考虑到GFR水平，CKD被分为五个阶段。第1阶段：肾脏损伤但GFR正常（大于90 ml/分钟）。第2阶段：GFR轻度降低（60 - 89 mL/分钟）。第3a阶段：GFR中度降低（45至59 mL/分钟）。第3b阶段：GFR中度降低（30至44 mL/分钟）。第4阶段：GFR严重降低（（15至29 mL/分钟）。第5阶段：肾衰竭（GFR低于15 mL/分钟）。
