Chronic Kidney Disease:
A neglected public health crisis that can be prevented

今天，全世界估计有8.5亿人患有慢性肾脏疾病(CKD)。¹. This is approximately twice the number of people with diabetes². 仍然, CKD的严重程度没有反映在仍然滞后的公共卫生政策中, especially when compared to other non-communicable diseases (NCDs)³.

它是 a silent and progressive disease that thrives when undetected. 未确诊CKD的总体患病率在其早期阶段尤其高, 何时可以开始有效的管理，以减缓或避免肾功能的恶化⁴. 然而, 人们在出现任何症状之前就失去了90%的肾功能，这并不罕见.⁵

然而,, the ever-increasing spread of CKD is far from inevitable. 好消息是:已经有了准确而廉价的检测方法来检测慢性肾病. 政策制定者可以采取一种综合方法，在一项系统预防计划中针对高危人群，该计划整合了针对其他非传染性疾病的现有规划. 事实上, 早期CKD筛查策略应优先考虑具有常见和重要CKD危险因素(如高血压和糖尿病)的人群⁶. 这种全面的愿景是必要的，因为非传染性疾病往往存在于具有共同风险因素的集群中. 澳门第一赌城在线娱乐在如何管理CKD并为患者提供更好的治疗结果方面还在等待什么?

CKD is also a leading cause of health expenditure worldwide, and its burden weighs heavily on individuals and healthcare systems alike.⁷

肾功能衰竭, annual costs of dialysis and 肾脏 transplantation alone range between USD 35,000美元和100美元,000 /例⁸.

此外，慢性肾病的社会和心理影响被严重低估³. 患有肾脏疾病的患者可能会经历严重的身体限制, loss of quality of life, emotional and cognitive disorders, social isolation and premature death³. 慢性肾病也会给环境留下持久的印记，因为所有的治疗都有相当大的碳足迹，并造成严重的污染³. Because CKD’s damage is as multidimensional as extensive, identifying it at the earliest stages is definitely an equity imperative.

With approximately 10% of the world’s population living with CKD, it is currently the third fastest-growing major cause of death worldwide^9,10. The need for immediate action is now more urgent than ever. 它是, 因此, 澳门第一赌城在线娱乐必须努力减轻预防原发性慢性肾病的障碍.

3月10日, I had the pleasure to take part in the Chronic Kidney Disease Summit, hosted by the Swedish Pavilion at EXPO Dubai 2020. In partnership with AstraZeneca, this platform brought together policymakers, 卫生保健工作者, and health stewards from the 肾脏 community to bridge the policy gap on CKD.

2019冠状病毒病大流行痛苦地暴露了医疗系统的脆弱性，慢性肾病患者处于这场风暴的核心. CKD is one of the most prevalent risk factors for severe COVID-19¹¹. 这些情况应该是一个警钟，要求澳门第一赌城在线娱乐改变导致澳门第一赌城在线娱乐的卫生保健系统在面对大流行时失败的范例. To build back more resilient post-COVID-19 systems, we must learn from CKD. 其管理的盲点是澳门第一赌城在线娱乐结构性短视政策视角的一个令人大开眼界的例子. 凯蒂和, Chief Executive Officer of the NCD Alliance, underlined our opportunity to act; “How can we accelerate action on CKD? 澳门第一赌城在线娱乐需要确保在全球非传染性疾病政策应对中反映和优先考虑这一点, within Universal Health Coverage responses, 和现在一样, within pandemic preparedness and response agendas.”

因此，慢性肾病最有力的教训之一就是预防胜于治疗. Not only is it critical for patients, 但它也会减少后期侵入性治疗的社会经济和环境成本, decrease cardiovascular death⁴防止大流行后卫生保健系统长期超负荷运转. Dr. 菲奥娜Adshead, Chair of the Sustainable Healthcare Coalition reminded us, “The most sustainable healthcare of all is prevention and early detection. 它是 quite clear that we can reduce the human cost, economic and the environmental costs by really focusing on that.出于这个原因, 现在是时候用一种投资心态来对待医疗保健政策了，要考虑到早期筛查和预防的机会成本. 

评估和管理早期CKD的指南是可用的，但由于缺乏激励措施或优先考虑CKD护理的措施质量，尚未被普遍采用⁶

The paradigm shift we call on depends upon the engagement of all stakeholders. CKD早期筛查的实施工作应该让政策制定者参与进来, 主要临床医生, and the community at large in an iterative process⁶.  克里斯·福布斯, Chief Executive Officer of Kidney Health Australia, said we collectively can change the paradigm, from 肾脏 failure to 肾脏 preservation.

最后, it is important to highlight the words of Jane DeMeis, a patient advocate who emphasized CKD is not a death sentence. 然而,, 改善公共政策需要全球努力，总结经验教训，并提供机会，分享和传播成功的战略. 从澳门在线赌城娱乐承诺到2025年在全球诊断1.4亿患者，到泰国的循证病例研究, 中国, 乌拉圭, 和埃及, 我相信，在这次慢性肾脏疾病峰会期间进行的讨论将为积极的政策制定和真正的变革铺平道路. 

引用:

1.Jager KJ，等. 一个倡导和沟通的数字——全世界有超过8.5亿人患有肾脏疾病. Nephrol Dial Transplant. 2019;34(11):1803-1805
2.NCD Alliance (互联网). Leaving no one behind: New partnership to promote a broader NCD agenda. [引自2022年2月]. Available from: http://ncdalliance.org/sites/default/files/resource_files/LeaveNoOneBehind_EndocrineReport_FINAL_for_website_0.pdf
3.Vanholder R，等. 与忽视肾脏健康的不可承受之轻作斗争:肾脏的十年. Clin Kidney J (互联网). 2021 [引自2022年2月] ;14(7):1719–30. Available from: http://dx.doi.org/10.1093 / ckj / sfab070
4.International Society of Nephrology (互联网). Early diagnosis of chronic 肾脏 disease. [引自2022年2月]. Available from: http://www3.weforum.org/docs/WEF_CKD_discussion_paper_PHSSR.pdf
5.世界肾脏日. (互联网). 慢性肾病. [引自2021年6月7日]. Available from: URL: http://www.world肾脏day.org/facts/chronic-肾脏-disease/#:~:text=A%20person%20can%20lose%20up,the%20urine%20and%20foamy%20urine.   
6.Shlipak MG，等. 早期识别和干预慢性肾脏疾病的案例:来自肾脏疾病:改善全球结果(KDIGO)争议会议的结论. 肾Int[互联网]. 2021 [引自2022年2月].;99(1):34–47. Available from: http://dx.doi.org/10.1016/j.号.2020.10.012
7.Luyckx等人. 与肾脏健康有关的可持续发展目标:最新进展情况. Nature Reviews Nephrology. 2021年1月,17 (1):15-32. http://doi.org/10.1038/s41581-020-00363-6
8.李建平，等. 2017年及以后的全球肾脏健康:缩小护理、研究和政策差距的路线图. 柳叶刀(互联网). 2017;390(10105):1888–917. Available from: http://dx.doi.org/10.1016/s0140-6736(17)30788-2
9.National Kidney Foundation (互联网). Global Facts: About Kidney Disease. [引自2022年2月]. Available from: http://www.肾脏.org/肾脏disease/global-facts-about-肾脏-disease#_ENREF_1
10.Neuen BL, Chadban SJ, Demaio AR, Johnson DW, Perkovic V. 慢性肾病 and the global NCDs agenda. BMJ Glob Health 2017;2(2):e000380
11.ERA-EDTA Council, ERACODA Working Group. 慢性肾脏疾病是严重COVID-19的关键风险因素:ERA-EDTA呼吁采取行动. Nephrol Dial Transplant (互联网). 2021 [引自2022年2月];36(1):87–94. Available from: http://dx.doi.org/10.1093 /无损检测/ gfaa314