Division of Cardiology and Kidney Health Research Collaborative, University of California, San Francisco, California, USA
Division of General Internal Medicine and Kidney Health Research Collaborative, University of California, San Francisco, California, USA.
Heart. 2021 Aug;107(16):1282-1288. doi: 10.1136/heartjnl-2020-318004. Epub 2021 Feb 10.
Globally, nearly 10% of the population has chronic kidney disease (CKD), defined as a glomerular filtration rate less than 60 mL/min/1.73 m and/or a urinary albumin to creatinine ratio greater than 30 mg/g (3 mg/mmol). Persons with CKD have a substantially high risk of cardiovascular disease. Indeed, most persons with CKD are far more likely to develop a cardiovascular event than to progress to end-stage kidney disease. Although early detection and staging of CKD could help prevent its cardiovascular consequences, current rates of testing for CKD are very low, even among high-risk populations such as persons with diabetes, hypertension and cardiovascular disease. In this review, we first describe the need to test for both estimated glomerular filtration rate and albuminuria among persons at high risk of CKD in order to properly stage CKD and enhance cardiovascular risk stratification. We then discuss how detection and staging for CKD could help prioritise patients at high risk of atherosclerotic cardiovascular disease and heart failure who could derive the largest benefit from cardiovascular preventive interventions. In addition, we discuss the central role of CKD detection and staging in the initiation of cardiorenal preventive therapies, such as the sodium-glucose cotransporter 2 inhibitors, which have shown overwhelming evidence of cardiorenal protection. We conclude by discussing strategies to overcome historical barriers to CKD detection and treatment.
在全球范围内，近 10%的人口患有慢性肾脏病（CKD），定义为肾小球滤过率低于 60mL/min/1.73m2 和/或尿白蛋白与肌酐比值大于 30mg/g（3mg/mmol）。CKD 患者发生心血管疾病的风险极高。事实上，大多数 CKD 患者发生心血管事件的可能性远高于进展为终末期肾病。尽管早期检测和分期 CKD 有助于预防其心血管后果，但目前 CKD 的检测率非常低，即使在高危人群中，如糖尿病、高血压和心血管疾病患者也是如此。在这篇综述中，我们首先描述了在 CKD 高危人群中检测估算肾小球滤过率和白蛋白尿的必要性，以便正确分期 CKD 并增强心血管风险分层。然后，我们讨论了如何通过检测和分期 CKD 来确定哪些患有动脉粥样硬化性心血管疾病和心力衰竭风险较高的患者可能从心血管预防干预中获益最大。此外，我们还讨论了 CKD 检测和分期在启动心脏肾脏预防治疗中的核心作用，如钠-葡萄糖共转运蛋白 2 抑制剂，它们已经显示出对心脏肾脏保护的压倒性证据。最后，我们讨论了克服 CKD 检测和治疗历史障碍的策略。
