Li Philip Kam-Tao, Garcia-Garcia Guillermo, Lui Siu-Fai, Andreoli Sharon, Fung Winston Wing-Shing, Hradsky Anne, Kumaraswami Latha, Liakopoulos Vassilios, Rakhimova Ziyoda, Saadi Gamal, Strani Luisa, Ulasi Ifeoma, Kalantar-Zadeh Kamyar
Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Jal., Mexico.
Indian J Nephrol. 2020 Mar-Apr;30(2):63-71. doi: 10.4103/ijn.IJN_50_20. Epub 2020 Feb 26.
The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5 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.
慢性肾脏病（CKD）的全球负担正在迅速增加，预计到2040年将成为全球寿命损失年数的第五大常见原因。令人担忧的是，CKD是灾难性医疗支出的主要原因。在高收入国家，透析和移植的费用消耗了高达3%的年度医疗预算。然而，至关重要的是，CKD的发病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措施的重要性——无论是一级、二级还是三级预防。这篇补充文章重点概述和分析了每个国家可以实施的促进和推进CKD预防的措施。肾脏疾病的一级预防应侧重于改变风险因素、解决肾脏和尿路的结构异常，以及避免接触环境风险因素和肾毒素。对于已有肾脏疾病的人，二级预防，包括优化血压和控制血糖，应成为教育和临床干预的主要目标。对于晚期CKD患者，管理尿毒症和心血管疾病等合并症是一种高度推荐的预防干预措施，以避免或延迟透析或肾脏移植。需要做出政治努力来推广预防方法。虽然一个国家可能存在针对非传染性疾病的国家政策和战略，但往往缺乏针对CKD筛查、管理和治疗的教育和认识的具体政策。因此，迫切需要提高全体民众、专业人员和政策制定者对预防措施重要性的认识。
