Division of Nephrology, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Division of Nephrology, University of Minnesota, Minneapolis, Minnesota, USA.
Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA.
Kidney Int. 2021 Jul;100(1):35-48. doi: 10.1016/j.kint.2021.04.029. Epub 2021 May 5.
Chronic kidney disease (CKD) affects about 10% of all populations worldwide, with about 2 million people requiring dialysis. Although patients with CKD are at high risk of cardiovascular disease and events, they are often underrepresented or excluded in clinical trials, leading to important knowledge gaps about how to treat these patients. KDIGO (Kidney Disease: Improving Global Outcomes) convened the fourth clinical Controversies Conference on the heart, kidney and vasculature in Dublin, Ireland, in February 2020, entitled Central and Peripheral Arterial Diseases in Chronic Kidney Disease. A global panel of multidisciplinary experts from the fields of nephrology, cardiology, neurology, surgery, radiology, vascular biology, epidemiology, and health economics attended. The objective was to identify key issues related to the optimal detection, management, and treatment of cerebrovascular diseases, central aortic disease, renovascular disease, and peripheral artery disease in the setting of CKD. This report outlines the common pathophysiology of these vascular processes in the setting of CKD, describes best practices for their diagnosis and management, summarizes areas of uncertainty, addresses ongoing controversial issues, and proposes a research agenda to address key gaps in knowledge that, when addressed, could improve patient care and outcomes.
慢性肾脏病（CKD）影响着全球约 10%的人群，其中约有 200 万人需要接受透析。尽管 CKD 患者罹患心血管疾病和相关事件的风险较高，但他们在临床试验中往往代表性不足或被排除在外，这导致了在如何治疗这些患者方面存在重要的知识空白。KDIGO（肾脏疾病：改善全球预后）于 2020 年 2 月在爱尔兰都柏林召开了第四次关于心脏、肾脏和血管的临床争议会议，主题为慢性肾脏病中的中心和外周动脉疾病。来自肾脏病学、心脏病学、神经病学、外科学、放射学、血管生物学、流行病学和卫生经济学等多学科领域的全球多学科专家小组参加了会议。会议的目的是确定与 CKD 患者的脑血管疾病、主动脉中心疾病、肾血管疾病和外周动脉疾病的最佳检测、管理和治疗相关的关键问题。本报告概述了 CKD 患者中这些血管过程的常见病理生理学，描述了其诊断和管理的最佳实践，总结了不确定领域，解决了正在讨论的争议问题，并提出了一个研究议程，以解决知识方面的关键空白，这些问题如果得到解决，将能够改善患者的护理和预后。
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