Department of Family Medicine, University of California Irvine Medical Center, Orange, CA, 92868, USA.
Diabetes Research Centre, University of Leicester, Leicester, UK.
Adv Ther. 2024 Oct;41(10):3757-3770. doi: 10.1007/s12325-024-02957-z. Epub 2024 Aug 20.
Early-stage (stage 1-3) chronic kidney disease (CKD) has an asymptomatic presentation such that most people with CKD are unaware of their disease status and remain undiagnosed. CKD is associated with multiple long-term conditions (MLTC), or multimorbidity, the most common of these being cardiovascular disease, hypertension, and type 2 diabetes. Primary care practitioners (PCPs) are crucial in the early identification and management of patients with CKD. For individuals at high risk of CKD, measurements of estimated glomerular filtration rate, urine albumin-creatinine ratio, and blood pressure should be obtained regularly and recorded in a timely manner. The importance of lifestyle changes in the prevention and management of CKD should also be highlighted. A recent addition to the treatment of CKD in people with and without type 2 diabetes has been the recommendation by clinical practice guidelines of a sodium-glucose co-transporter 2 (SGLT2) inhibitor alongside a renin-angiotensin-aldosterone system inhibitor as foundational therapy. SGLT2 inhibitors prevent CKD progression and reduce fatal and non-fatal kidney and cardiovascular events, hospitalization for heart failure, and all-cause mortality, and they have a favorable safety and tolerability profile. However, uptake has been slow, particularly in people with CKD without type 2 diabetes. A multifaceted approach is required to ensure that people with CKD receive optimal kidney protection. Measures to raise awareness of the importance of early identification and intervention include local/national campaigns via social media and practice-based education; clinical education programs; integration of clinical decision support tools into electronic health records; detection programs built around electronic health records; and good interdisciplinary communication. PCPs at the forefront of multidisciplinary care are best placed to implement the evidence-based clinical practice CKD guidelines for lifestyle modification and guideline-directed medical therapy.
早期（1-3 期）慢性肾脏病（CKD）呈无症状表现，因此大多数 CKD 患者都不知道自己的疾病状况，也未被诊断出来。CKD 与多种长期疾病（MLTC）或合并症相关，其中最常见的是心血管疾病、高血压和 2 型糖尿病。初级保健医生（PCP）在早期识别和管理 CKD 患者方面至关重要。对于有 CKD 高风险的个体，应定期测量估算肾小球滤过率、尿白蛋白-肌酐比值和血压，并及时记录。还应强调生活方式改变在预防和管理 CKD 中的重要性。最近，除了 2 型糖尿病患者以外，临床实践指南还推荐在治疗 CKD 时使用钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂联合肾素-血管紧张素-醛固酮系统抑制剂作为基础治疗。SGLT2 抑制剂可预防 CKD 进展，减少致命和非致命性肾脏和心血管事件、心力衰竭住院以及全因死亡率，并且具有良好的安全性和耐受性。然而，采用率一直较低，尤其是在没有 2 型糖尿病的 CKD 患者中。需要采取多方面的方法来确保 CKD 患者得到最佳的肾脏保护。提高对早期识别和干预重要性的认识的措施包括通过社交媒体和基于实践的教育进行地方/国家宣传活动；临床教育计划；将临床决策支持工具整合到电子健康记录中；围绕电子健康记录建立检测计划；以及良好的跨学科沟通。处于多学科护理前沿的 PCP 最适合实施基于证据的 CKD 指南，以进行生活方式改变和指南导向的药物治疗。
