Reducing the burden of chronic kidney disease among American Indians
Reducing the burden of chronic kidney disease among American Indians
复制标题
DOI：
10.1053/j.ackd.2008.01.011
复制
发表时间：
2008-04-01
影响因子：
2.9
通讯作者：
Narva, Andrew S.
中科院分区：
文献类型：
--
作者：
Narva, Andrew S.
在过去的半个世纪里，美洲印第安人（AI）和阿拉斯加原住民（AN）的2型糖尿病及其相关并发症（包括慢性肾病（CKD））急剧增加。在2005年底，终末期肾病（ESRD）的国家患病率在AI/AN是2.5倍以上的白色美国人，与美国西南部的社区显着更高。合并糖尿病的AIs/ANs中CKD的证据包括30%的蛋白质排泄异常和17%的估计肾小球滤过率（eGFR）< 60 mL/min/m2。为了解决CKD日益加重的负担，印度卫生局建立了肾脏疾病计划，以改善CKD糖尿病患者的筛查和管理。eGFR的常规报告、蛋白排泄的年度监测、肾素-血管紧张素系统（RAS）拮抗剂的使用和血压的积极控制与加强的患者和提供者教育相关。到2006年，82%的高血压糖尿病患者正在接受RAS拮抗剂治疗。这些努力的实施与患有糖尿病的AI/AN中ESRD发病率下降31%相关。由一个为资源有限的高危人群服务的联邦机构实施的CKD护理改善计划可能是其他人的有用模式。(c)2008年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
American Indians (AIs) and Alaska Natives (ANs) have experienced a dramatic rise in type 2 diabetes and associated complications, including chronic kidney disease (CKD) over the past half century. At the end of 2005, the national prevalence of end-stage renal disease (ESRD) in AIs/ANs was 2.5 times greater than that for white Americans, with rates significantly higher among communities of the southwest United States. Evidence of CKD among AIs/ANs with diabetes includes abnormal protein excretion in 30% and estimated glomerular filtration rate (eGFR) < 60 mL/min/m(2) in 17%. In order to address the growing burden of CKD, the Indian Health Service established the Kidney Disease Program to improve the screening of and the management of diabetics with CKD. Routine reporting of eGFR, yearly monitoring of protein excretion, utilization of renin-angiotensin system (RAS) antagonists, and aggressive control of blood pressure were implemented in association with enhanced patient and provider education. By 2006, 82% of hypertensive diabetics were receiving a RAS antagonist. Implementation of these efforts has been associated with a 31% decrease in ESRD incidence among AIs/ANs with diabetes. This program of improvements in CKD care implemented by a federal agency serving a high-risk population with limited resources may be a useful model for others. (c) 2008 by the National Kidney Foundation, Inc.