Screening for chronic kidney disease: Where does Europe go?
Screening for chronic kidney disease: Where does Europe go?
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DOI：
10.2215/cjn.04381007
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发表时间：
2008-03-01
影响因子：
9.8
通讯作者：
Zoccali, Carmine
中科院分区：
文献类型：
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作者：
de Jong, Paul E.;van der Velde, Marije;Zoccali, Carmine
这篇综述讨论了在欧洲使用的慢性肾脏疾病的各种筛查方法。不同项目中定义慢性肾脏疾病的标准不同，但通常限于估计的肾小球滤过率，因此仅提供3期及以上慢性肾脏疾病的数据;然而，筛查不应仅限于测量估计的肾小球滤过率，还应包括微量白蛋白尿的测量，因为这将提供1期和2期慢性肾脏疾病的识别。确定这些早期阶段是重要的，因为与1期和2期相关的终末期肾病的风险几乎等于与3期相关的风险。此外，第1阶段和第2阶段的心血管事件风险与第3阶段相同。各种报告认为，在全科医生或门诊办公室的筛查项目的成本很高，并且当它们仅限于目标群体（如糖尿病或高血压患者和老年人）时，它们仅在预防终末期肾病方面具有成本效益。然而，筛查计划的益处不应仅在预防肾脏事件方面进行评估，还应包括预防心血管事件的益处。在许多欧洲国家，已发现基于受损的估计肾小球滤过率或蛋白试纸阳性或晨尿白蛋白尿升高的预选作为靶向筛查的替代方案是有效的。
This review discusses various screening approaches for chronic kidney disease that are used in Europe. The criterion for defining chronic kidney disease in the various programs differs but is frequently limited to estimated glomerular filtration rate, thus offering only data on chronic kidney disease stages 3 and higher; however, screening should not be limited to measuring only estimated glomerular filtration rate but should also include a measure of microalbuminuria, because this will offer identification of chronic kidney disease stages 1 and 2. Defining these earlier stages is of importance because the risk for developing end-stage renal disease that is associated with stages 1 and 2 is nearly equal to the risk that is associated with stage 3. Moreover, the risk for cardiovascular events in stages 1 and 2 is equal to that in stage 3. Various reports argue that costs of screening programs in general practitioner or outpatient offices are high and that they are cost-effective only for preventing end-stage renal disease when they are limited to target groups, such as patients with diabetes or hypertension and elderly. The benefits of screening programs, however, should not be evaluated only with respect to the prevention of renal events but should also include the benefits of preventing cardiovascular events. The use of preselection based on either an impaired estimated glomerular filtration rate or on protein-dipstick positivity or elevated albuminuria in a morning urine void has been found effective in various European countries as an alternative for targeted screening.