社区慢性肾脏病筛查的研究进展
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摘要
随着人口老龄化进程及糖尿病、高血压等患病率的增加,慢性肾脏病(CKD)的患病率明显增加。由于预后不良及终末期治疗成本巨大,CKD已经成为严重的公共卫生问题之一。早期筛查识别并开展早期干预治疗,可延缓CKD病情进展,改善患者预后。但目前对CKD筛查的重视程度不够,筛查率较低。全科医生在CKD筛查中承担着重要角色,以社区筛查为基础的多方合作有利于宣传、展开筛查及转诊。本文在梳理相关文献的基础上,发现目前CKD筛查方式和筛查危险因素的选择尚存在争议;筛查的实施建议借助互联网;筛查项目建议以相关指南推荐为基础,同时符合成本效果的无创筛查项目也正在研究中,高效筛查频次也需要更多证据。此外,社区CKD筛查仍需进行进一步的成本效果分析,从而为真实世界中筛查的实施提供更多证据。
With the aging of population and increase of diabetes and hypertension prevalence rates,the prevalence rate of chronic kidney disease(CKD) is also obviously increased.Due to poor prognosis and huge treatment costs in the endstage,CKD has become a severe public health problem.In fact,early screening and early treatment can delay the progression and improve the prognosis of CKD.However,the screening rate is low due to insufficient attention.General practitioners play an important role in CKD screening.Community-based screening of CKD co-implemented by multiple parties helps to publicize CKD screening knowledge,implement the screening and transfer the patients.On the basis of literature review,we found that there is a dispute about the selection of screening modes and risk factors.We suggest that the Internet can be used as an assistant tool for the implementation of CKD screening,and screening programs can be based on the guideline recommendations.Besides,new costeffective and non-invasive screening programs are being studied.Also,frequency of high-efficient screening needs more evidence.In addition,community-based CKD screening project needs further verification of its cost-effectiveness,which offers more evidence for the screening implementation.
With the aging of population and increase of diabetes and hypertension prevalence rates,the prevalence rate of chronic kidney disease(CKD) is also obviously increased.Due to poor prognosis and huge treatment costs in the endstage,CKD has become a severe public health problem.In fact,early screening and early treatment can delay the progression and improve the prognosis of CKD.However,the screening rate is low due to insufficient attention.General practitioners play an important role in CKD screening.Community-based screening of CKD co-implemented by multiple parties helps to publicize CKD screening knowledge,implement the screening and transfer the patients.On the basis of literature review,we found that there is a dispute about the selection of screening modes and risk factors.We suggest that the Internet can be used as an assistant tool for the implementation of CKD screening,and screening programs can be based on the guideline recommendations.Besides,new costeffective and non-invasive screening programs are being studied.Also,frequency of high-efficient screening needs more evidence.In addition,community-based CKD screening project needs further verification of its cost-effectiveness,which offers more evidence for the screening implementation.
引文
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[20]JOHNSON D W,ATAI E,CHAN M,et al.KHA-CARIguideline:early chronic kidney disease:detection,prevention and management[J].Nephrology,2013,18(5):340-350.DOI:10.1111/nep.12052.
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[24]GEORGE C,MOGUEO A,OKPECHI I,et al.Chronic kidney disease in low-income to middle-income countries:the case for increased screening[J].BMJ Glob Health,2017,2(2):e000256.DOI:10.1136/bmjgh-2016-000256.
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[27]HOWARD K,SALKELD G,WHITE S L,et al.Thecosteffectiveness of early detection and intervention to prevent the progression of chronic kidney disease in Australia[M].Melbourne:Kidney Health Australia,2006.
[28]OLMOS R D.Screening for chronic kidney disease and inequity[J].Sao Paulo Med J,2016.DOI:10.1590/1516-3180.2016.0082080516.
[29]BOCHUD M.On the rationale of population screening for chronic kidney disease:a public health perspective[J].Public Health Rev,2015,36:11.DOI:10.1186/s40985-015-0009-9.
[30]MOYER V A.Screening for chronic kidney disease:US preventive services task force recommendation statement[J].Ann Intern Med,2012,157(8):567-570.DOI:10.7326/0003-4819-157-8-201210160-00533.
[31]潘玉静,张路霞.估算肾小球滤过率的评价方法[J].中华内科杂志,2016,55(3):237-240.DOI:10.3760/cma.j.issn.0578-1426.2016.03.019.PAN Y J,ZHANG L X.Evaluation method for estimating glomerular filtration rate[J].Chinese Journal of Internal Medicine,2016,55(3):237-240.DOI:10.3760/cma.j.issn.0578-1426.2016.03.019.
[32]KLAHR S,LEVEY A S,BECK G J,et al.The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease.Modification of Diet in Renal Disease Study Group[J].N Engl J Med,1994,330(13):877-884.DOI:10.1056/NEJM199403313301301.
[33]RATNAYAKE S,BADURDEEN Z,NANAYAKKARA N,et al.Screening for chronic kidney disease of uncertain aetiology in Sri Lanka:usability of surrogate biomarkers over dipstick proteinuria[J].BMC Nephrol,2017,18(1):199.DOI:10.1186/s12882-017-0610-x.
[34]PEREZMONTEOLIVA N R,FELIX F J,LOZANO L,et al.The HUGE formula(hematocrit,urea,sex)for screening chronic kidney disease(CKD)in an age-stratified general population[J].Journal of Nutrition Health&Aging,2015,19(6):688-692.DOI:10.1007/s12603-015-0504-1.
[35]PHAM T A.Validation of the salivary urea and creatinine tests as screening methods of chronic kidney disease in Vietnamese patients[J].Acta Odontol Scand,2017,75(8):551-556.DOI:10.1080/00016357.2017.1356467.
[36]MAO F,LIU S Y,QIAO X N,et al.Sudoscan,an effective tool for screening chronic kidney disease in patients with type 2diabetes[J].Exp Ther Med,2017,14(2):1343-1350.DOI:10.3892/etm.2017.4689.
[37]SAXENA A,GUPTA A,ABRAHAM G,et al.Non-invasive screening tool for chronic kidney disease[J].Saudi J Kidney Dis Transpl,2015,26(6):1311-1313.DOI:10.4103/1319-2442.168697.
[38]WANG H Y,YANG L,WANG F,et al.Strategies and costeffectiveness evaluation of persistent albuminuria screening among high-risk population of chronic kidney disease[J].BMCNephrol,2017,18(1):135.DOI:10.1186/s12882-017-0538-1.
[39]BANG H,MAZUMDAR M,NEWMAN G,et al.Screening for kidney disease in vascular patients:Screening for Occult Renal Disease(SCORED)experience[J].Nephrol Dial Transplant,2009,24(8):2452-2457.DOI:10.1093/ndt/gfp124.
[40]ASHTON C W,DUFFIE D.Chronic kidney disease in Canada's First Nations:results of an effective cross-cultural collaboration[J].Healthc Q,2011,14(3):42-47.
[41]CURTIS C,BALINT C,AL HAMARNEH Y N,et al.Online clinical pathway for managing adults with chronic kidney disease[J].Can Pharm J(Ott),2015,148(5):257-262.DOI:10.1177/1715163515597243.
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[2]BELLO A K,LEVIN A,TONELLI M,et al.Assessment of global kidney health care status[J].JAMA,2017,317(18):1864-1881.DOI:10.1001/jama.2017.4046.
[3]MILLS K T,XU Y,ZHANG W D,et al.A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010[J].Kidney Int,2015,88(5):950-957.DOI:10.1038/ki.2015.230.
[4]MATHEW T,CORSO O.Review article:early detection of chronic kidney disease in Australia:which way to go[J].Nephrology(Carlton),2009,14(4):367-373.DOI:10.1111/j.1440-1797.2009.01113.x.
[5]郑法雷.慢性肾脏疾病筛查的必要性和实施方法[J].诊断学理论与实践,2007,6(6):475-477.DOI:10.3969/j.issn.1671-2870.2007.06.001.ZHENG F L.Necessity and implement methods of screening chronic kidney disease[J].Journal of Diagnostics Concepts&Practice,2007,6(6):475-477.DOI:10.3969/j.issn.1671-2870.2007.06.001.
[6]JHA V,GARCIA-GARCIA G,ISEKI K,et al.Chronic kidney disease:global dimension and perspectives[J].Lancet,2013,382(9888):260-272.DOI:10.1016/S0140-6736(13)60687-X.
[7]GOLESTANEH L,ALVAREZ P J,REAVEN N L,et al.Allcause costs increase exponentially with increased chronic kidney disease stage[J].Am J Manag Care,2017,23(10 suppl):s163-172.
[8]JOMMI C,ARMENI P,BATTISTA M,et al.The cost of patients with chronic kidney failure before dialysis:results from OST of patients with chronic kidney failure before dialysis:results from the IRIDE observational study[J].Pharmacoecon Open,2018,2(4):459-467.DOI:10.1007/s41669-017-0062-z.
[9]ZHANG L,WANG F,WANG L,et al.Prevalence of chronic kidney disease in China:across-sectional survey[J].The Lancet,2012,379(9818):815-822.DOI:10.1016/S0140-6736(12)60033-6.
[10]GALBRAITH L,HEMMELGARN B,MANNS B,et al.The association between individual counselling and health behaviour change:the See Kidney Disease(SeeKD)targeted screening programme for chronic kidney disease[J].Can J Kidney Health Dis,2016,3:35.DOI:10.1186/s40697-016-0127-4.
[11]ZHANG L X,LONG J Y,JIANG W S,et al.Trends in chronic kidney disease in China[J].N Engl J Med,2016,375(9):905-906.DOI:10.1056/NEJMc1602469.
[12]JOHNSON D W.Evidence-based guide to slowing the progression of early renal in sufficiency[J].Internal Medicine Journal,2004:50-57.DOI:10.1111/j.1444-0903.2004.t01-6-x.
[13]VAN DER VELDE M,HALBESMA N,DE CHARRO F T,et al.Screening for albuminuria identifies individuals at increased renal risk[J].J Am Soc Nephrol,2009,20(4):852-862.DOI:10.1681/ASN.2008060655.
[14]QASEEM A,HOPKINS R H,SWEET D E,et al.Screening,monitoring,and treatment of stage 1 to 3 chronic kidney disease:a clinical practice guideline from the American College of Physicians[J].Ann Intern Med,2013,159(12):835-847.DOI:10.7326/0003-4819-159-12-201312170-00726.
[15]LAVALLEE B,CHARTRAND C,MCLEOD L,et al.Mass screening for chronic kidney disease in rural and remote Canadian first nations people:methodology and demographic characteristics[J].Canadian Journal of Kidney Health and Disease,2015,2(1):1-10.DOI:10.1186/s40697-015-0046-9.
[16]上海慢性肾脏病早发现及规范化诊治与示范项目专家组.慢性肾脏病筛查诊断及防治指南[J].中国实用内科杂志,2017,37(1):28-34.DOI:10.19538/j.nk2017010108.Expert Group on Early Detection,Diagnosis and Treatment System Construction of Chronic Kidney Disease in Shanghai.Guideline for screening,diagnosis,prevention and treatment of chronic kidney disease[J].Chinese Journal of Practical Internal Medicine,2017,37(1):28-34.DOI:10.19538/j.nk2017010108.
[17]GO D S,KIM S H,PARK J,et al.Cost-utility analysis of the National Health Screening Program for chronic kidney disease in Korea[J].Nephrology(Carlton),2019,24(1):56-64.DOI:10.1111/nep.13203.
[18]KOMENDA P,FERGUSON T W,MACDONALD K,et al.Cost-effectiveness of primary screening for CKD:a systematic review[J].Am J Kidney Dis,2014,63(5):789-797.DOI:10.1053/j.ajkd.2013.12.012.
[19]MANNS B,HEMMELGARN B,TONELLI M,et al.Population based screening for chronic kidney disease:cost effectiveness study[J].BMJ,2010,341:c5869.DOI:10.1136/bmj.c5869.
[20]JOHNSON D W,ATAI E,CHAN M,et al.KHA-CARIguideline:early chronic kidney disease:detection,prevention and management[J].Nephrology,2013,18(5):340-350.DOI:10.1111/nep.12052.
[21]National Clinical Guideline Centre(UK).Chronic kidney disease(partial update):early identification and management of chronic kidney disease in adults in primary and secondary care[EB/OL].[2019-01-10].https://www.nice.org.uk/.
[22]Ministry of Health.Chronic kidney disease:identification,evaluation and management of adult patients[EB/OL].[2019-01-10].https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bcguidelines/ckd-full-guideline.pdf.
[23]Ministry of Health.Managing chronic kidney disease in primary care:national consensus statement[EB/OL].[2019-01-10].https://www.health.govt.nz/system/files/documents/publications/managing-chronic-kidney-disease-primary-care-mar15-v2.pdf.
[24]GEORGE C,MOGUEO A,OKPECHI I,et al.Chronic kidney disease in low-income to middle-income countries:the case for increased screening[J].BMJ Glob Health,2017,2(2):e000256.DOI:10.1136/bmjgh-2016-000256.
[25]FLOOD D,GARCIA P,DOUGLAS K,et al.Screening for chronic kidney disease in a community-based diabetes cohort in rural Guatemala:a cross-sectional study[J].BMJ Open,2018,8(1):e019778.DOI:10.1136/bmjopen-2017-019778.
[26]GHEEWALA P A,ZAIDI S T R,JOSE M D,et al.Effectiveness of targeted screening for chronic kidney disease in the community setting:a systematic review[J].J Nephrol,2018,31(1):27-36.DOI:10.1007/s40620-017-0375-0.
[27]HOWARD K,SALKELD G,WHITE S L,et al.Thecosteffectiveness of early detection and intervention to prevent the progression of chronic kidney disease in Australia[M].Melbourne:Kidney Health Australia,2006.
[28]OLMOS R D.Screening for chronic kidney disease and inequity[J].Sao Paulo Med J,2016.DOI:10.1590/1516-3180.2016.0082080516.
[29]BOCHUD M.On the rationale of population screening for chronic kidney disease:a public health perspective[J].Public Health Rev,2015,36:11.DOI:10.1186/s40985-015-0009-9.
[30]MOYER V A.Screening for chronic kidney disease:US preventive services task force recommendation statement[J].Ann Intern Med,2012,157(8):567-570.DOI:10.7326/0003-4819-157-8-201210160-00533.
[31]潘玉静,张路霞.估算肾小球滤过率的评价方法[J].中华内科杂志,2016,55(3):237-240.DOI:10.3760/cma.j.issn.0578-1426.2016.03.019.PAN Y J,ZHANG L X.Evaluation method for estimating glomerular filtration rate[J].Chinese Journal of Internal Medicine,2016,55(3):237-240.DOI:10.3760/cma.j.issn.0578-1426.2016.03.019.
[32]KLAHR S,LEVEY A S,BECK G J,et al.The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease.Modification of Diet in Renal Disease Study Group[J].N Engl J Med,1994,330(13):877-884.DOI:10.1056/NEJM199403313301301.
[33]RATNAYAKE S,BADURDEEN Z,NANAYAKKARA N,et al.Screening for chronic kidney disease of uncertain aetiology in Sri Lanka:usability of surrogate biomarkers over dipstick proteinuria[J].BMC Nephrol,2017,18(1):199.DOI:10.1186/s12882-017-0610-x.
[34]PEREZMONTEOLIVA N R,FELIX F J,LOZANO L,et al.The HUGE formula(hematocrit,urea,sex)for screening chronic kidney disease(CKD)in an age-stratified general population[J].Journal of Nutrition Health&Aging,2015,19(6):688-692.DOI:10.1007/s12603-015-0504-1.
[35]PHAM T A.Validation of the salivary urea and creatinine tests as screening methods of chronic kidney disease in Vietnamese patients[J].Acta Odontol Scand,2017,75(8):551-556.DOI:10.1080/00016357.2017.1356467.
[36]MAO F,LIU S Y,QIAO X N,et al.Sudoscan,an effective tool for screening chronic kidney disease in patients with type 2diabetes[J].Exp Ther Med,2017,14(2):1343-1350.DOI:10.3892/etm.2017.4689.
[37]SAXENA A,GUPTA A,ABRAHAM G,et al.Non-invasive screening tool for chronic kidney disease[J].Saudi J Kidney Dis Transpl,2015,26(6):1311-1313.DOI:10.4103/1319-2442.168697.
[38]WANG H Y,YANG L,WANG F,et al.Strategies and costeffectiveness evaluation of persistent albuminuria screening among high-risk population of chronic kidney disease[J].BMCNephrol,2017,18(1):135.DOI:10.1186/s12882-017-0538-1.
[39]BANG H,MAZUMDAR M,NEWMAN G,et al.Screening for kidney disease in vascular patients:Screening for Occult Renal Disease(SCORED)experience[J].Nephrol Dial Transplant,2009,24(8):2452-2457.DOI:10.1093/ndt/gfp124.
[40]ASHTON C W,DUFFIE D.Chronic kidney disease in Canada's First Nations:results of an effective cross-cultural collaboration[J].Healthc Q,2011,14(3):42-47.
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