Chronic Kidney Disease: Common, Harmful and Treatable – World Kidney Day 2007

摘要: T hursday, March 8, 2007, is World Kidney Day! Day was proposed by the International Society of Nephrology and Federation Foundations in 2006 to broadcast a message about kidney diseases public, government health officials, general physicians, allied professionals, individuals, families. It launched on 9, 2006, will be fully inaugurated this year (http://www.worldkidneyday.org/). The that disease common, harmful, treatable. In article, we focus chronic (CKD) as global public problem urgent need for all countries have policy CKD. Until recently, decision makers biomedical science had viewed CKD uncommon, without consequences, untreatable until stage failure. care patients with been marginalized, relegated subspecialty nephrology, payment primarily directed at dialysis transplantation, which are too costly vast majority people who live outside developed world. At same time, costs other mounting. countries, hypertension, diabetes, cardiovascular (CVD) consume large fraction resources care. epidemic obesity magnify these costs, young well elderly. developing burden noncommunicable rising even though communicable not yet under control. We now recognize especially common multiplies risk adverse outcomes costs. mandate clear. No country can afford overlook CKD; prevention, early detection, intervention only cost-effective strategies. following paragraphs, outline rationale key elements integrating programs diseases. Rationale Figure 1 shows conceptual model basis approach, emphasizing stages CKD, antecedents, outcomes, factors development progression defined either damage, estimated from markers such albuminuria, or GFR 60 ml/min per 1.73 m 3 mo more (1–3). Albuminuria usually spot urine protein-to-creatinine ratio 30 mg/g, serum creatinine, age, gender, race. United States, recent data National Health Nutrition Examination Survey (NHANES) estimate prevalence 9.6% noninstitutionalized adults, corresponding approximately 19 million (Table 1) (4,5). elderly, racial ethnic minorities, those lower socioeconomic status disproportionately affected. Prevalence estimates difficult interpret because differences creatinine levels result variability among studies assays, muscle mass, diet. Nonetheless, both nations, consistent picture emerging increased CVD established CVD. most important include complications decreased failure but also Many show albuminuria each consistently graded manner increase (6). Indeed, showed 100 times likely die, principally CVD, than develop (7). There convincing efficacy treatment prevent GFR, slow disease, reduce risk. Testing feasible clinical practice, methods applied large-scale screening Therefore, tools improve already available. time establish policies translate advances health.