Chronic kidney disease in low-income to middle-income countries: the case for increased screening.
Chronic kidney disease in low-income to middle-income countries: the case for increased screening.
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DOI：
10.1136/bmjgh-2016-000256
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发表时间：
2017
影响因子：
8.1
通讯作者：
Kengne AP
中科院分区：
文献类型：
--
作者：
George C;Mogueo A;Okpechi I;Echouffo-Tcheugui JB;Kengne AP
慢性肾脏疾病(CKD)正在迅速成为一个主要的公共卫生问题，给发现率仍然很低的中等收入国家带来了不成比例的低收入负担。我们对现有的关于低收入到中等收入国家慢性肾脏病筛查的文献进行了严格的评估。我们执行了PubMed搜索，直到2016年9月，关于低收入到中等收入国家CKD筛查的研究。相关研究通过从威尔逊和准格纳标准得出的关键问题进行总结。我们发现，低收入到中等收入国家没有足够的装备来应对慢性肾脏病的破坏性后果，特别是疾病的晚期。在这些国家，有一些可接受的相对简单的工具可以帮助进行CKD筛查。筛查应主要包括高危个人(患有高血压、2型糖尿病、艾滋病毒感染或60岁老年人)，但也应扩大到风险水平低于最佳水平的人(如糖尿病前期和高血压前期)。由于在资源匮乏的情况下，高血压、2型糖尿病和艾滋病毒感染的筛查已经包括在临床实践指南中，可以想象将其与简单的CKD筛查测试相结合。CKD筛查的有效实施仍然是一项挑战，这项工作的成本效益在很大程度上仍有待探索。总而言之，由于许多令人信服的原因，慢性肾脏病筛查应成为低收入至中等收入国家的政策优先事项，因为早期干预很可能有效地减少慢性肾脏病发病率和死亡率的高负担。这将有助于卫生系统实现具有成本效益的预防。
Chronic kidney disease (CKD) is fast becoming a major public health issue, disproportionately burdening low-income to middle-income countries, where detection rates remain low. We critically assessed the extant literature on CKD screening in low-income to middle-income countries. We performed a PubMed search, up to September 2016, for studies on CKD screening in low-income to middle-income countries. Relevant studies were summarised through key questions derived from the Wilson and Jungner criteria. We found that low-income to middle-income countries are ill-equipped to deal with the devastating consequences of CKD, particularly the late stages of the disease. There are acceptable and relatively simple tools that can aid CKD screening in these countries. Screening should primarily include high-risk individuals (those with hypertension, type 2 diabetes, HIV infection or aged >60 years), but also extend to those with suboptimal levels of risk (eg, prediabetes and prehypertension). Since screening for hypertension, type 2 diabetes and HIV infection is already included in clinical practice guidelines in resource-poor settings, it is conceivable to couple this with simple CKD screening tests. Effective implementation of CKD screening remains a challenge, and the cost-effectiveness of such an undertaking largely remains to be explored. In conclusion, for many compelling reasons, screening for CKD should be a policy priority in low-income to middle-income countries, as early intervention is likely to be effective in reducing the high burden of morbidity and mortality from CKD. This will help health systems to achieve cost-effective prevention.
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影响因子：
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作者：
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通讯作者：
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影响因子：
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影响因子：
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通讯作者：
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