Jardine Meg J, Kasiske Bertram, Adu Dwomoa, Alrukhaimi Mona, Ashuntantang Gloria E, Basnet Shakti, Chailimpamontree Worawon, Craig Jonathan C, O'Donoghue Donal J, Perkovic Vlado, Powe Neil R, Roberts Charlotte J, Suzuki Yusuke, Tanaka Tetsuhiro, Uhlig Katrin
Renal & Metabolic Division, The George Institute for Global Health, University of New South Wales Sydney, New South Wales, Australia.
Nephrology Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Kidney Int Suppl (2011). 2017 Oct;7(2):114-121. doi: 10.1016/j.kisu.2017.07.006. Epub 2017 Sep 20.
There are major gaps between our growing knowledge of effective treatments for chronic kidney disease (CKD), and the delivery of evidence-based therapies to populations around the world. Although there remains a need for new, effective therapies, current evidence suggests that many patients with CKD are yet to fully realize the benefits of blood pressure-lowering drugs (with and without reducing proteinuria with renin-angiotensin system blockade), wider use of statins to reduce atherosclerotic cardiovascular disease events, and better glycemic control in both type 1 and type 2 diabetes. There are many barriers to optimizing evidence-based nephrology care around the world, including access to health care, affordability of treatments, consumer attitudes and circumstances, the dissemination of appropriate knowledge, the availability of expertise and structural impediments in the delivery of health care. Further investment in implementation science that addresses the major barriers to effective care in a cost-effective manner could yield both local and global benefits.
我们对慢性肾脏病（CKD）有效治疗方法的认识不断增加，但在向全球人群提供循证治疗方面仍存在重大差距。尽管仍需要新的有效疗法，但目前的证据表明，许多CKD患者尚未充分认识到降压药物（无论是否通过肾素-血管紧张素系统阻滞剂降低蛋白尿）、更广泛使用他汀类药物以减少动脉粥样硬化性心血管疾病事件以及更好地控制1型和2型糖尿病患者血糖所带来的益处。在全球范围内，优化循证肾脏病护理存在许多障碍，包括获得医疗保健的机会、治疗费用、消费者态度和情况、适当知识的传播、专业知识的可得性以及医疗保健提供中的结构障碍。以具有成本效益的方式对解决有效护理主要障碍的实施科学进行进一步投资，可能会带来本地和全球效益。
