prevention and treatment of chronic kidney disease, attention to blood pressure monitoring2017-03-03 11:05
The second Thursday of March is defined as World Kindey Day (WKD), which aims to give people greater attention to kidney health, reduce the incidence of kidney disease, reduce kidney disease and the resulting Damage caused by related problems. March 12, 2009, is the fourth world kidney day. This year's theme emphasizes the role of hypertension in kidney disease, "hypertension in CKD". "Keep the pressure down" is the slogan of the year.
Hypertension and kidney disease are two causal diseases. Hypertension is one of the main causes of kidney damage. And kidney disease is a common cause of high blood pressure, especially difficult to control high blood pressure. Therefore, the control of blood pressure has become an important aspect of the treatment of chronic kidney disease (CKD).
How can I learn to suffer from CKD?
The current guidelines recommend the use of estimated glomerular filtration rate (eGFR) to evaluate renal function. This indicator is more important for the evaluation of renal function. CKD was divided into 5 periods according to eGFR.
1 kidney damage (such as proteinuria), GFR normal, greater than 90ml / min
2 cases of renal injury, GFR decreased slightly, 60-89ml / min
3 GFR moderate decline, 30 -59ml / min
4 GFR serious decline, 29ml / min
5 patients with renal failure (need dialysis or kidney transplantation), GFR less than 15ml / min
In addition, it is recommended to check urinary protein or urinary albumin.
Although CKD has the above simple screening indicators, but CKD patients awareness is still very low. Taiwan's figures show that screening of nearly half a million people found that 12% had CKD. In these diagnosed CKD patients, less than 4% of people knew their illness before. CKD population died of cardiovascular disease risk than the CKD population increased several times; high blood pressure in the pathogenesis of cardiovascular disease plays an important role.
The prevalence of CKD worldwide
The prevalence of CKD is increasing worldwide. The most common cause of CKD is hypertension and diabetes. CKD is closely related to increased cardiovascular risk. EGFR down to 60 mL / min below, further increase the risk of cardiovascular disease, CKD patients are more died of cardiovascular disease rather than uremia. Therefore, CKD has now become a world public health problem.
About high blood pressure
Hypertension is also a public health problem around the world. Hypertension is a major risk factor for the development and progression of kidney disease in patients with diabetes and non-diabetic CKD. There are nearly 1 billion hypertensive patients worldwide (blood pressure> 140/90 mm Hg), and by 2025, this figure is expected to grow to 1.56 billion. The current global population aging, the elderly are the occurrence of hypertension, diabetes and CKD these chronic disease risk factors. CKD patients with the progress of staging, the proportion of hypertension increased, up to 80% or higher. However, the control of hypertension is not optimistic. Although governments and health departments continue to work, the prevalence of hypertension, awareness and treatment rate has improved, but the blood pressure control rate is still low.
Systolic and diastolic pressure who is more closely associated with kidney and cardiovascular disease?
Based on current evidence, it is agreed that systolic blood pressure on cardiovascular disease and kidney disease more than diastolic pressure greater. US KEEP study shows that poor blood pressure control is mainly manifested as systolic blood pressure is not up to standard.
What is the goal of blood pressure control for CKD patients?
According to different kidney disease guidelines, systolic blood pressure should be controlled below 130mmHg. For diabetics, the guidelines suggest that blood pressure control targets should be lower, which will allow patients to benefit further, but the current prospective study is not yet supported by the epidemiological survey.
Diabetes and CKD
As mentioned earlier, diabetes and hypertension are the most common risk factors for CKD. There are 240 million people with diabetes in the world, and it is expected to grow to 380 million by 2025. This growth is related to population growth, aging, urbanization, unhealthy eating habits, increased obesity, and less lifestyle. China is one of the top five countries with diabetes (India, China, the United States, Russia and Japan). More than 50% of the world's diabetic patients are not known about their illness, let alone treatment. In addition, the crowd still exists a lot of people with diabetes, such as obesity, family history, high blood pressure, old age, too little exercise, unhealthy diet. Should start from the control of these risk factors to prevent them from developing into diabetes. When diabetes and CKD exist at the same time, will greatly increase the risk of suffering from cardiovascular disease.
The lack of CKD diagnosis and treatment is a worldwide problem. This is not only manifested in patients with low awareness of its illness, but also for doctors on CKD risk factors (such as high blood pressure, diabetes) awareness rate is low, the latter is more worrying. In addition, even if the risk factors for CKD to understand, but its treatment is not sufficient; this treatment may be inadequate due to the patient's own factors, may also come from a doctor or both. Therefore, CKD is still a challenging issue. For example, data from 1999 to 2006 show that less than 5% of CKD patients with eGFR less than 60 mL / min / 1.73 m2 and proteinuria are known to be sick; CKD has progressed to Phase 3 Patients, only 7.5% awareness; less than 50% of patients in stage 4. Diabetes or hypertension and associated with CKD3.4 patients with a higher awareness rate, but only 20% and 12%. To change the status quo of low CKD awareness, the important one is to strengthen the education of doctors related knowledge. For example, a study shows that one-third of US family doctors do not think that family history is a risk factor for CKD. Nearly one-fourth do not know that African Americans are at risk for CKD; most doctors are aware of diabetes and high blood pressure Is a risk factor for CKD (95% and 97%, respectively). But the problem remains that even if it is recognized that diabetes and hypertension are risk factors for CKD, the rate of control is low. In patients who have been treated, their control rate (reaching the guideline standard) is less than 50%.
How to solve this problem?
In recent years, many experts have been published to promote better control of blood pressure. And try to change the status quo through the following ways, including raising public awareness, conducting screening programs and educating patients and doctors. US KEEP screening program let us see that when the patient is aware of their own illness, blood pressure control standards is very possible. The Bolivian study noted that patients with CKD were treated with CKD risk factors (such as control of blood pressure). Many countries around the world have already started work on the KEEP program. World Kidney Day This year's theme emphasizes the role of hypertension in CKD "hypertension in CKD" (http: // www.worldkidneyday.org). With the aging population in the world and the increase in the prevalence of hypertension and diabetes, the prevalence of CKD is also increasing. Which will greatly increase the burden of medical expenses. By 2005, the cost of treatment for ESRD in the United States is expected to reach $ 32 billion. Therefore, countries urgently need to start to take some measures to carry out the prevention of CKD and CKD patients with early diagnosis and treatment. One of the important work is to do a good job of high blood pressure screening and treatment. The International Society of Nephrology and the International Kidney Funds Association advocate long-term work around the world, requiring each individual, especially people with diabetes, to understand their own blood pressure levels. When the blood pressure exceeds the normal level, it should start treatment.
Hypertension treatment includes: lifestyle changes, regular exercise, diet for blood pressure and health is very important. Weight loss is good for blood pressure control. Reducing alcohol intake is sometimes helpful for blood pressure control. The treatment of drugs is equally important, including antihypertensive drugs, lipid-lowering drugs and the treatment of CKD complications such as anemia. Blood pressure control requirements. Government departments also play an important role in CKD prevention and control. Such as advocating the reduction of salt intake in the diet, requiring labeling of food on the sodium content. These devices have been proven to be very effective in reducing cardiovascular morbidity and mortality.
From the above can be learned, CKD prevention and control work is still very difficult. Colleagues, let us from now on, from their own start, know CKD, found CKD, treatment CKD, from the beginning to control blood pressure!