慢性肾脏病在社区的筛查和干预——困惑与挑战

Screening of Chronic Kidney Disease in Communities:confusion and challenges

目的通过对社区危险人群中慢性肾脏病(CKD)的筛查,反映全科医生在慢性肾脏病防治、管理中面临的困惑与挑战。方法以北京大学医学部社区为单位,2008年5月—2009年10月对本院门诊就医的608例高血压患者给予常规肾功能检查,使用国际通用的MDRD公式计算肾小球滤过率(eGFR),筛查早期CKD,并给予相应的健康教育与健康管理。结果608例高血压患者中,肾功能不同程度受损者共计287例,占47.2%;符合CKD诊断标准者145例,高血压人群CKD的患病率为23.8%。对以往患有高血压而血肌酐正常尚未诊断慢性肾脏病的58例患者,根据MDRD公式计算eGFR<90ml/min,其中eGFR在60～89ml/min者27例(男16例,女11例;尿常规异常者8例);eGFR在30～59ml/min者31例(男10例,女21例;尿常规异常者7例)。这58例患者中合并糖尿病15例。经改变生活方式,并加强对原发病治疗后病情好转23例。结论社区高血压人群的CKD患病率较高,并且有相当一部分患者血肌酐尚在正常范围。如能通过全科医生对此类人群早期筛查,早期干预,同时给予规范的健康管理,将能大大延缓和控制CKD的病情,相应遏制由此产生的巨额医疗资源的消耗,有利于指导治疗、监测病情和改善预后。

Objective To reflect, through chronic kidney diseases （CKD） screening in community risk population, the confusion and challenges that general practitioners are facing in the prevention and treatment of CKD. Methods Conventional kidney function test was conducted in 608 hypertensive out - patients in our hospital from May 2008 to October 2009. Internationally accepted MDRD formula was used to calculate glomerular filtration rate （eGFR） , early CKD was screened, and relevant health education and management performed. Results Of 608 hypertensive patients, 287 had varying degrees of impaired renal function, accounting for 47. 2% ; 145 met the diagnostic criteria for CKD, and CKD prevalence rate of hypertensive population was 23.8%. The kidney function calculated by the formula was less than 90 ml/min in 58 hypertensive patients with normal serum ereatinine who had not been diagnosed as CKD, including 27 with eGFR of 60 - 89mL/min （ 16 males, 11 females, 8 with abnormal routine urinanaysis） and 31 with eGFR of 30 -59 ml/min （ 10 males, 21 were females; 7 with abnormal routine urinalysis）. Fifteen patients were complicated by diabetes. After lifestyle changes and primary disease treatment, 23 patients improved. Conclusion CKD prevalence is relatively high in community hypertensive population, a considerable number of whom have normal serum creatinine. If general practitioners provide this population with early screening, intervention and standard health management, CKD can be greatly slowed down or controlled, thus to reduce huge consumption of medical resources and help to guide treatment, monitor patientsbonditions and improve prognoses.