基层医疗环境中的慢性肾脏病:一篇叙述性综述。

Chronic kidney disease in the primary care setting: A narrative review.

作者信息

Safdar Faryal, Aslam Ahsan

机构信息

Indiana University Fairbanks School of Public Health Indianapolis Indiana USA.

Indiana University School of Medicine Indianapolis Indiana USA.

出版信息

J Gen Fam Med. 2025 Jul 29;26(5):385-393. doi: 10.1002/jgf2.70054. eCollection 2025 Sep.

Abstract

Chronic kidney disease (CKD) is a growing public health concern globally, with primary care physicians (PCPs) playing a pivotal role in its early detection and management. This review explores the epidemiology, risk factors, screening strategies, and clinical manifestations of CKD within primary care settings. PCPs are integral in recognizing at-risk populations, initiating timely screening through eGFR and albuminuria tests, and managing modifiable risk factors like hypertension and diabetes. The article discusses current guideline-recommended pharmacologic therapies-including RAAS inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and non-steroidal MRAs-that slow disease progression. Lifestyle modifications and dietary interventions are emphasized as essential components of care. Additionally, the review outlines key indications for nephrology referral and the management of common CKD complications, such as anemia and mineral-bone disorder. By embracing a proactive and multidisciplinary approach, PCPs can significantly influence CKD outcomes, reduce progression to end-stage renal disease, and improve overall patient prognosis.

摘要

慢性肾脏病(CKD)是全球日益受到关注的公共卫生问题,基层医疗医生(PCP)在其早期检测和管理中发挥着关键作用。本综述探讨了基层医疗环境中CKD的流行病学、危险因素、筛查策略和临床表现。基层医疗医生对于识别高危人群、通过估算肾小球滤过率(eGFR)和蛋白尿检测及时启动筛查以及管理可改变的危险因素(如高血压和糖尿病)不可或缺。本文讨论了当前指南推荐的药物治疗,包括肾素-血管紧张素-醛固酮系统(RAAS)抑制剂、钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂、胰高血糖素样肽-1(GLP-1)受体激动剂和非甾体盐皮质激素受体拮抗剂(MRAs),这些药物可减缓疾病进展。生活方式改变和饮食干预被强调为护理的重要组成部分。此外,该综述概述了肾病转诊的关键指征以及常见CKD并发症(如贫血和矿物质-骨代谢紊乱)的管理。通过采取积极主动的多学科方法,基层医疗医生可以显著影响CKD的治疗结果,减少进展至终末期肾病的风险,并改善患者的总体预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c963/12404170/8767a21a072d/JGF2-26-385-g003.jpg

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