Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong.
Iran J Kidney Dis. 2020 Mar;14(2):69-80.
The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. Crucially, however, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be it primary, secondary, or tertiary. This complementing article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention; including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness of the importance of preventive measures throughout populations, professionals and policy makers.
全球慢性肾脏病（CKD）的负担正在迅速增加，预计到 2040 年，CKD 将成为全球导致寿命损失的第五大主要原因。更糟糕的是，CKD 是导致灾难性医疗支出的主要原因之一。透析和移植的费用占高收入国家年度医疗保健预算的 3%。然而，至关重要的是，CKD 的发生和进展通常是可以预防的。2020 年，世界肾脏日活动强调了预防干预的重要性——无论是一级、二级还是三级预防。本文重点阐述和分析了可以在每个国家实施的措施，以促进和推进 CKD 的预防。预防肾病的一级预防应侧重于对危险因素的调整，以及解决肾脏和尿路的结构异常，以及暴露于环境危险因素和肾毒物的问题。对于已经患有肾脏疾病的人，二级预防；包括血压优化和血糖控制，应成为教育和临床干预的主要目标。在患有晚期 CKD 的患者中，管理尿毒症和心血管疾病等合并症是避免或延迟透析或肾移植的高度推荐的预防干预措施。需要政治努力来推广预防方法。虽然一个国家可能已经有了针对非传染性疾病的国家政策和战略，但针对 CKD 筛查、管理和治疗的具体政策往往缺乏。因此，迫切需要提高整个人群、专业人员和决策者对预防措施重要性的认识。
