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医疗特色

世界肾脏日:重视肾脏的时代已经来临
来源:阜阳市二院作者:李龙海发布时间:08-09-13浏览次数(6804

Collins AJ, Couser WG, Dirks JH, Kopple JD, Reiser T, Riella MC, Robinson S, Shah SV, Wilson A.

    Developed by the International Federation of Kidney Foundations(IFKF) and the International Society of Nephrology (ISN), Committeefor World Kidney Day.

 

国际肾脏病学会(ISN)和国际肾脏基金联合会(IFKF)联合倡议每年3月份的第二个星期四为“世界肾脏日”。此举的主要目的是希望引起全球对慢性肾脏疾病(chronic renal diseases, CKD)及相关的心血管疾病重视。并借此将肾脏病信息传送给政府的卫生官员、全体医生以及相关专业人员、个人和家庭。

从全世界来看,大多数患有慢性肾脏疾病或高血压的患者没有得到早期诊断。即使诊断了也没有得到治疗或良好的治疗。至今终末期肾脏病患者在大多数国家和地区还无法接受透析或移植治疗,只有死亡。

为此,现在是我们大声疾呼的时候了。因为,肾脏疾病不被重视已有很长时间。实际上,虽然我们已有简单易行的早期发现和有效的防治方法,但是,还没有被广泛知晓和应用。因此,现在是引起全世界人们的重视时候,同时,还要让人们知道治疗此病每年需要数十百亿美元的巨额负担。

慢性肾脏疾病和糖尿病、高血压及心血管疾病具有相互关系,CKD是导致上述疾病高发生和高死亡的重要原因,并造成健康保险的巨额负担。CKD也明显增加心脑血管疾病的危险性。实际上,肾脏疾病可通过简单的常规方法进行检测,如检查血肌酐、尿蛋白等而发现。慢性肾脏疾病以及相关的心血管并发症也可以有效预防和治疗的方法,如良好的控制血压、控制血糖和降低血脂等。肾脏保护措施如ACEIARB的应用可以。延缓或阻止CKD的发展。因此对肾脏病的重视不仅是一个公众的健康问题,从而,  减少了终末期肾病以同时也减少了其相关的心血管疾病。

过去,曾有公共卫生学和生物医学专家认为肾脏疾病不是一个常见和花费巨大的疾病。然而,最新的证据表明,患肾脏病的人数远多于人们的想象。在发达国家每年诊治100多万肾脏病人中,大约25万为新增病人。在美国和荷兰,普通人群中有6.5%10%患有不同程度的肾脏疾病,如此可见其严重性。随着糖尿病和高血压发病率的增高,肾脏疾病也在发展中国家快速增长。然而,由于每例透析的费用每年需65000美金,肾移植每年也需40000美金,因此,除发达国家外,大多数病人都无法得到适当的治疗。

一些新的资料显示,ESRD病人增加的速度减慢了,此在一些人群中确实如此。但这些现象与糖尿病人群应用ACEIARB,血压、血糖得到良好控制有关。然而,Ⅱ型糖尿病及相关的代谢综合征仍是全球的大问题,还有很多的工作要做。就全球而言,到2030年Ⅱ型糖尿病病人将增加至154360百万人。其中至少40%有肾脏疾病,也增加心血管疾病的危险性。如果不能早期诊断和治疗,将有10%以上的病人发展至终末期肾病(ESRD)。因此,我们必须尽最大努力减少终末期肾脏病的发生,至少应减慢肾脏病发展的进程。

对于政府来说,重视肾脏疾病又是一个明显的公共健康问题。因为早期发现和预防是最有效的防治慢性肾脏疾病及其相关糖尿病和心血管疾病的方法。其内容包括:良好的血压控制,尽早提醒肾科医生进行全面的干预治疗,包括接种流感、肺炎球菌疫苗等,就可减少CKD病人由于感染而住院率的机率4倍以上;而精确的血肌酐和尿蛋白的检测则有利于慢性肾脏病人肾功能的监测。

接受透析或移植的病人最直接的原因就是肾脏疾病。早期发现和干预治疗可挽救受损的肾脏。ESRD两个主要病因高血压和糖尿病,两者具有明显的基因关联性,因此,肾脏病人应重视家族性遗传问题。遗传性疾病如多囊肾,有明显的家族遗传性。在一些发展中国家,疟疾、AIDS、结核和儿童感染如小儿腹泻等可引起肾脏疾病。如何及时处理好急性肾衰竭(ARF),以及去除一些是可逆的,导致肾脏损害的情况,也可明显减少相关疾病的患病率和死亡率。在一些国家,还不能很好地诊断和治疗肾结石。世界肾脏日可在所有的议题方面教育我们的医生和民众。

一些国际医学组织已经建立了相应的国际日来引起人们对特殊疾病的认识。建立这样一个特殊的日子就是呼吁个人和家庭重视这个问题,并根据早期的症状和简单的实验室检查作出早期诊断。ISNIFKF建立世界肾脏日——使之成为唤起人们关注和了解肾脏疾病的重要途径。我们希望全世界各国肾脏病学会和肾脏基金会联合起来,共同创建世界肾脏日,使之象其他国际日一样得到世界认可。

媒体的关注,病人的访问,社区的重视以及职业教育等都会产生足以影响大众对预防和早期治疗慢性肾脏疾病的认识。如果不予治疗,慢性肾脏疾病作为一个重要疾病将会成为重大的公共健康问题。

200639是第一个世界肾脏日,也将为200738日正式建立世界肾脏日做准备。所有肾科医生的参与是关键。我们希望世界肾脏日将不仅是北美和欧洲的重要日子,也是发展中国家的重要日子。挑战愈大,我们的责任更重大。让我们团结起来,从现在开始,共同克服肾脏疾病和心血管疾病的世界难题,为民造福。

参与译文专家:

中华医学会肾脏病学分会副主任委员  余学清教授

国际肾脏病学会理事 林善锬教授

国际肾脏病学会理事 王海燕教授

中华医学会肾脏病学分会常务委员 郑法雷教授

中华医学会肾脏病学分会副主任委员 李学旺教授

中华医学会肾脏病学分会主任委员 陈香美教授

J Am Soc Nephrol.2006 Feb 1

SPECIAL ANNOUNCEMENT

World Kidney Day: An Idea Whose Time Has Come

Collins AJ, Couser WG, Dirks JH, Kopple JD, Reiser T, Riella MC, Robinson S, Shah SV, Wilson A.

   Developed by the International Federation of Kidney Foundations(IFKF) and the International Society of Nephrology (ISN), Committeefor World Kidney Day.

 THE WORLD NEEDS a kidney day to draw global attention to theincreasing global pandemic of kidney and associated cardiovasculardisease. Therefore, the International Society of Nephrology (ISN)and the International Federation of Kidney Foundations (IFKF)jointly are proposing that a World Kidney Day be established on thesecond Thursday in March each year. It will be launched onThursday, March 9, 2006, and fully inaugurated on Thursday, March8, 2007. The aim is to broadcast the message about kidney diseaseto government health officials, general physicians, allied healthprofessionals, individuals, and families.

     Worldwide, most individuals with chronickidney disease or hypertension are not diagnosed until long afterthe illness has developed. Moreover, when they are diagnosed, theytoo often are treated suboptimally or not at all. In most parts ofthe world, once end-stage kidney failure occurs, patients do nothave access to maintenance hemodialysis treatment or kidneytransplantation and simply die.

     For these reasons, it is time to speak upand to speak clearly, because the extent and severity of kidneydisease has not been appreciated for a long time. Moreover, theavailability of easy methods for early detection and the provenbenefits of preventive therapy are not widely known. A day whenattention to kidney disease is brought to the worlds population is timely. It could also serve as a day to expressappreciation for the billions of dollars of support for a diseasethat currently requires high-technology treatment.

     Kidney disease is a significantinteractive disease in patients with diabetes, hypertension, andcardiovascular disease with major morbidity and mortalityconsequences and high costs to the healthcare system. Moreover,patients with chronic kidney disease have a marked increase in riskfor developing cardiovascular disease. However, as kidney diseaseis easy to detect with simple, routinely available tests (serumcreatinine and urine albumin), both chronic kidney disease and thepotential associated cardiovascular complications can be preventedand effectively treated with intensive blood pressure control,glucose control in diabetic patients, lipid-lowering medications,and the use of kidney-protective medications such asangiotensin-converting enzyme inhibitors or angiotensin receptorblockers. Prevention and slowing the progression of chronic kidneydisease are the only rational public health approaches toaddressing the ever-increasing numbers of patients with end-stagerenal disease and reducing the associated cardiovascular risk inthese patients.

     The decision makers of public health andbiomedical science view kidney disease as infrequent and costly.However, newer information and scientific evidence have givenpersuasive proof that there is more kidney disease than had beenthought. Developed countries worldwide treat more than 1,000,000individuals yearly, and as many as 250,000 new cases each year.1 In the United States and The Netherlands, it is estimated that6.5% to 10% of the general population suffer from some degree ofkidney disease and are therefore at increased risk of preventablecardiovascular disease and renal failure. Kidney disease isincreasing rapidly in the developing world, along with theprevalence of diabetes and hypertension. However, since dialysiscosts can average $65,000 per year and transplantation can cost upto $40,000, neither is available to the vast majority of peopleliving outside the developed world.

     Some emerging evidence points out thatend-stage renal disease rates are slowing and, in fact, decreasingin certain populations. These trends are consistent with increaseduse of angiotensin-converting enzyme inhibitors and angiotensinreceptor blockers and with better blood pressure control and bettercontrol of the blood sugar in diabetic patients. Yet, worldwidethere is a pandemic of type II diabetes and associated metabolicsyndrome, so there continues to be substantial room forimprovement. The number of patients with type II diabetes worldwidewill increase from 154 to 360 million by 2030, with at least 40% ofthese patients developing chronic kidney disease with itsassociated increased cardiovascular risk, and more than 10%developing end-stage renal disease unless aggressive measures ofearly detection and intervention programs are initiated.Intensified efforts should yield further reductions in end-stagerenal disease rates, at least in the short run, with more dataneeded to determine if decreases are sustainable.2

     The public health mandate is clear forgovernments: detection and prevention are the most cost-effectivemethods to address chronic kidney disease and its impact ondiabetes and cardiovascular disease. Targets have been defined forblood pressure. Early referral to nephrologists for more completeassessment of interventions, as well as other preventive caremeasures including influenza vaccinations and pneumococcalvaccinations, are needed to reduce hospitalization rates forinfectious complications that are four times higher in patientssuffering from chronic kidney disease.3 Detection efforts center on accurate measurements of serumcreatinine and albumin in the urine in the estimating equation toassess the level of kidney disease.4 Strategies to standardize these measurements should become aglobal priority.

     Patients who start dialysis or receivekidney transplants experience the most direct consequences ofkidney disease; early detection and intervention could have savedthe ravages of kidney failure. Because of genetic linkages betweendiabetes and hypertension, the leading causes of kidney failure,kidney disease runs in families. Genetic diseases, such aspolycystic kidney disease among others, and genetic abnormalitiesalso run in families. In some developing countries malaria, humanimmunodeficiency virus/acquired immunodeficiency syndrome,tuberculosis, and childhood infections such as diarrheal diseasesare significant causes of kidney disease. Awareness about how todeal with acute renal failure, which is reversible, could reduceboth unnecessary mortality and morbidity. In some countries thereis a lack of basic knowledge about diagnosing and treating kidneystones. A World Kidney Day could play an important role ineducating physicians and the public about all these issues.

     Several international medicalorganizations have established effective special days to drawattention to specific diseases. The primary purposes of these daysare to bring the specific disease to the forefront as an issue forpersonal/family health and to provide information about earlysymptoms and the simple clinical and laboratory tests available fordiagnosis. ISN and IFKF have decided it is time for ourorganizations to follow suit by establishing a World Kidney Dayone additional instrument to help achieve better understanding ofkidney disease. The hope is to enlist every national kidney societyand every local kidney foundation worldwide to join with us. Webelieve World Kidney Day will be recognized by world bodies asother special days have been.

     Media attention, interviews with affectedpatients, community awareness programs, and professional educationefforts all create awareness that affect public attitudes andbehaviors toward prevention and early treatment of the specificdisease being profiled. Kidney disease, with its devastatingconsequences when left untreated, is one that would benefit fromthis type of public exposure.

     An initial World Kidney Day on March 9,2006, will prepare the way for a full inauguration on March 8,2007. It will be vital that all nephrologists become involved. Itis our hope that World Kidney Day will be important not only toNorth America and Europe, but also in all developing countries, inplaces as diverse as Myanmar, Yemen, Angola, and Bolivia. Thechallenge is great, but the promise is even greater: that byworking together we can achieve a major reduction in the globalburden of kidney and cardiovascular disease. We must act, and actnow.

Allan J. Collins, MD, FACP

Committee Chair, IFKF

William G. Couser, MD

President, ISN

 John H. Dirks, MD

ISN

Joel D. Kopple, MD

IFKF

Thomas Reiser

Executive Director, ISN

Miguel C. Riella, MD

ISN

 Sheila Robinson, BA

ISN

 Sudhir V. Shah, MD

President, IFKF

Anne Wilson

Chief Executive Officer, IFKF


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