ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands.
Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
Nat Rev Nephrol. 2024 Sep;20(9):569-585. doi: 10.1038/s41581-024-00863-9. Epub 2024 Jul 18.
The burden of chronic kidney disease (CKD) and its risk factors are projected to rise in parallel with the rapidly ageing global population. By 2050, the prevalence of CKD category G3-G5 may exceed 10% in some regions, resulting in substantial health and economic burdens that will disproportionately affect lower-income countries. The extent to which the CKD epidemic can be mitigated depends largely on the uptake of prevention efforts to address modifiable risk factors, the implementation of cost-effective screening programmes for early detection of CKD in high-risk individuals and widespread access and affordability of new-generation kidney-protective drugs to prevent the development and delay the progression of CKD. Older patients require a multidisciplinary integrated approach to manage their multimorbidity, polypharmacy, high rates of adverse outcomes, mental health, fatigue and other age-related symptoms. In those who progress to kidney failure, comprehensive conservative management should be offered as a viable option during the shared decision-making process to collaboratively determine a treatment approach that respects the values and wishes of the patient. Interventions that maintain or improve quality of life, including pain management and palliative care services when appropriate, should also be made available.
慢性肾脏病（CKD）的负担及其危险因素预计将与全球人口的快速老龄化同步增加。到 2050 年，一些地区 G3-G5 期 CKD 的患病率可能超过 10%，从而导致巨大的健康和经济负担，这些负担将不成比例地影响低收入国家。CKD 流行程度在很大程度上取决于预防措施的采用，以解决可改变的危险因素，在高危人群中实施具有成本效益的 CKD 早期检测筛查计划，以及新世代肾脏保护药物的广泛可及性和可负担性，以预防 CKD 的发生和延缓其进展。老年患者需要多学科综合方法来管理他们的多种合并症、多种药物治疗、高不良结局率、心理健康、疲劳和其他与年龄相关的症状。对于那些进展为肾衰竭的患者，应在共同决策过程中提供全面的保守治疗管理，作为一种可行的选择，以共同确定一种治疗方法，尊重患者的价值观和意愿。还应提供维持或改善生活质量的干预措施，包括疼痛管理和姑息治疗服务（如有需要）。
