Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA; Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA.
Kidney Int. 2024 Mar;105(3):406-417. doi: 10.1016/j.kint.2023.12.003.
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
从历史上看，将新的治疗方法从临床证据转化为日常实践平均需要 17 年。鉴于现在有非常有效的治疗方法可用于预防或延缓肾脏病的发生和进展，这实在是太久了。现在是时候缩小我们所知道的和我们所做的之间的差距了。预防和管理肾脏病常见风险因素（如高血压和糖尿病）的明确指南已经存在，但全世界只有一小部分患有这些疾病的人得到诊断，而得到目标治疗的人就更少了。同样，绝大多数患有肾脏病的人都不知道自己的病情，因为在早期，肾脏病通常没有明显症状。即使在已经被诊断出患有肾脏病的患者中，也有许多人没有得到适当的肾脏病治疗。考虑到肾脏病进展、肾衰竭或死亡的严重后果，必须尽早且适当地开始治疗。必须从初级保健层面最大限度地利用早期诊断和治疗肾脏病的机会。从患者到临床医生，再到医疗体系和社会因素，存在着许多系统性障碍。为了保护和改善世界各地每个人的肾脏健康，必须承认这些障碍，以便尽快制定和实施可持续的解决方案。
