Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Head of Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Fla.
Am J Med. 2022 May;135(5):576-580. doi: 10.1016/j.amjmed.2021.11.019. Epub 2021 Dec 31.
Chronic kidney disease affects approximately 10% of the population or 800 million people globally, with diabetes being the leading cause. The presence of chronic kidney disease with impaired kidney function or with albuminuria is associated with an increased risk of a progressive loss of renal function and increased risk of cardiovascular disease and excess mortality. Screening for chronic kidney disease is critically important because during the initial stages patients often have no symptoms and because we now have available recently approved multiple interventions that can reduce the high risks dramatically. Screening should be performed with regular measurement of albumin in the urine and creatinine or cystatin C in blood for estimation of kidney function. Regretfully recent data indicates that screening for albuminuria is conducted in only 20%-50% of people at risk depending on the setting. Clinicians need to perform regular screening and concomitant management of risk factors. Recent therapeutic options must be implemented to improve outcomes. Finally, a reduction in albuminuria after initiation of intervention constitutes a treatment target because it indicates improved prognosis.
慢性肾脏病影响全球约 10%的人口或 8 亿人,其中糖尿病是主要病因。慢性肾脏病伴有肾功能受损或蛋白尿的患者,其肾功能进行性丧失风险和心血管疾病及死亡风险增加。慢性肾脏病的筛查至关重要,因为在早期阶段,患者通常没有症状,而且我们现在有多种新批准的干预措施,可以显著降低高风险。应通过定期测量尿液中的白蛋白和血液中的肌酐或胱抑素 C 来进行肾功能评估,进行筛查。遗憾的是,最近的数据表明,根据不同的情况,只有 20%-50%的高危人群进行了蛋白尿筛查。临床医生需要定期进行筛查,并同时管理危险因素。必须实施最近的治疗选择以改善预后。最后,干预后白蛋白尿的减少是一个治疗目标,因为这表明预后改善。