National kidney foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification
National kidney foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification
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DOI：
10.7326/0003-4819-139-2-200307150-00013
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发表时间：
2003-07-15
影响因子：
39.2
通讯作者：
Eknoyan, G
中科院分区：
文献类型：
--
作者：
Levey, AS;Coresh, J;Eknoyan, G
慢性肾脏疾病是一个全球性的公共卫生问题，其发病率和患病率不断增加，结局不佳，费用高昂。慢性肾脏疾病的结局不仅包括肾衰竭，还包括肾功能下降和心血管疾病的并发症。目前的证据表明，这些不良后果中的一些可以通过早期发现和治疗来预防或延迟。不幸的是，慢性肾脏疾病诊断不足和治疗不足，部分原因是缺乏对其进展阶段的定义和分类的一致性。国家肾脏基金会最近的临床实践指南1）定义慢性肾脏疾病并对其阶段进行分类，而不考虑潜在原因，2）评价用于肾脏疾病临床评估的实验室测量，3）将肾功能水平与慢性肾病并发症相关联，以及4）将肾功能丧失和心血管疾病发展的风险分层。该指南是通过使用的方法的基础上概述的程序由机构的医疗保健研究和Quality.This介绍了慢性肾脏病的定义和五个阶段的分类系统，并总结了在成人早期发现的主要建议。建议包括确定风险增加的人（糖尿病患者、高血压患者、有慢性肾病家族史的患者、60岁以上的患者或美国少数民族），通过测量不定时（“点”）尿标本中的白蛋白-肌酐比率来检测肾损伤，以及通过使用预测方程从血清肌酐测量值估计肾小球滤过率。由于一般人群中慢性肾脏疾病早期的患病率很高（约占成人的11%），因此这些信息对普通内科医生和专家特别重要。
Chronic kidney disease is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of chronic kidney disease include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Current evidence suggests that some of these adverse outcomes can be prevented or delayed by early detection and treatment. Unfortunately, chronic kidney disease is underdiagnosed and undertreated, in part as a result of lack of agreement on a definition and classification of its stages of progression.Recent clinical practice guidelines by the National Kidney Foundation 1) define chronic kidney disease and classify its stages, regardless of underlying cause, 2) evaluate laboratory measurements for the clinical assessment of kidney disease, 3) associate the level of kidney function with complications of chronic kidney disease, and 4) stratify the risk for loss of kidney function and development of cardiovascular disease. The guidelines were developed by using an approach based on the procedure outlined by the Agency for Healthcare Research and Quality.This paper presents the definition and five-stage classification system of chronic kidney disease and summarizes the major recommendations on early detection in adults. Recommendations include identifying persons at increased risk (those with diabetes, those with hypertension, those with a family history of chronic kidney disease, those older than 60 years of age, or those with U.S. racial or ethnic minority status), detecting kidney damage by measuring the albumin-creatinine ratio in untimed ("spot") urine specimens, and estimating the glomerular filtration rate from serum creatinine measurements by using prediction equations. Because of the high prevalence of early stages of chronic kidney disease in the general population (approximately 11% of adults), this information is particularly important for general internists and specialists.