Tangri Navdeep, Priest Stacey, Zara Anthony, Long Bo Ren, Chen Jieling, Rao Naveen, Froguel Clélia-Elsa, Robson Breonny, Guldemond Nick, Eckelman Matthew, Moura Ana Flavia, Audehm Ralph, Adshead Fiona, Zhao Ming-Hui, Wanner Christoph, Chadban Steven
University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Value & Evidence, EVERSANA, Burlington, Ontario, Canada.
Kidney Int Rep. 2025 Jun 6;10(8):2608-2620. doi: 10.1016/j.ekir.2025.05.039. eCollection 2025 Aug.
Chronic kidney disease (CKD) is an underdiagnosed and undertreated disease despite the availability of effective interventions. The potential clinical, economic, and environmental impacts of increased diagnosis and improved adherence to guideline-directed medical therapies (GDMTs) recommended for patients with CKD are not well-understood.
Eight country populations (Australia, Brazil, China, Germany, The Netherlands, Spain, UK, and USA) were simulated for 25 years using the IMPACT CKD model to compare burdens under various diagnosis and GDMT adherence scenarios versus current practice. GDMT consisted of kidney protecting, glucose lowering, lipid lowering, as well as antihypertensive and lifestyle interventions. Patients could be treated with 1 or multiple therapies, if eligible, and no guideline changes occurred over the time horizon. Treatment effects were assumed multiplicative.
Scenarios with improved GDMT adherence projected cumulative decreases in dialysis, cardiovascular (CV) events, and death by -3.2% to -23.2%, -12.2% to -41.4%, and -2.3% to -9.3%, respectively, compared with current practice over 10 years. Because of delayed CKD progression, kidney replacement therapy (KRT) costs and environmental burden were also projected to decrease by -2.5% to -19.4% and -2.7% to -21.2%, respectively, compared with current practice. All treatment scenarios predicted greater improvements over 25 years, underscoring the long-term impact of CKD, and highlighting the importance of early intervention.
Differences in projected impacts between countries are multifactorial, though they are sensitive to demographics and health care systems. Implementation of policies that lead to improved detection and treatment of CKD are urgently required across the globe to mitigate the growing burdens of CKD on patients and caregivers, health care systems, society, and our environment.
尽管有有效的干预措施，但慢性肾脏病（CKD）仍是一种诊断不足且治疗不充分的疾病。对于CKD患者，增加诊断和提高对指南指导的药物治疗（GDMT）的依从性所产生的潜在临床、经济和环境影响尚未得到充分了解。
使用IMPACT CKD模型对八个国家（澳大利亚、巴西、中国、德国、荷兰、西班牙、英国和美国）的人群进行了25年的模拟，以比较各种诊断和GDMT依从性情况下与当前实践相比的负担。GDMT包括肾脏保护、降糖、降脂以及抗高血压和生活方式干预。如果符合条件，患者可以接受1种或多种治疗，并且在整个时间范围内指南没有变化。假设治疗效果具有相乘性。
与当前实践相比，在10年期间，GDMT依从性提高的情况下，透析、心血管（CV）事件和死亡的累计降幅预计分别为-3.2%至-23.2%、-12.2%至-41.4%和-2.3%至-9.3%。由于CKD进展延迟，与当前实践相比，肾脏替代治疗（KRT）成本和环境负担预计也将分别降低-2.5%至-19.4%和-2.7%至-21.2%。所有治疗方案预计在25年内会有更大改善，这突出了CKD的长期影响，并强调了早期干预的重要性。
各国预计影响的差异是多因素的，尽管它们对人口统计学和医疗保健系统敏感。全球迫切需要实施能够改善CKD检测和治疗的政策，以减轻CKD对患者和护理人员、医疗保健系统、社会及环境日益增加的负担。
