慢性肾脏病(CKD)是一个全球性的公共卫生问题,具有重大的人类和经济后果。尽管临床指南取得了进展,分类系统和循证治疗,CKD仍未被诊断和治疗不足,预计到2040年将成为全球第五大死亡原因。这篇综述旨在确定有效检测的障碍和促成因素,诊断,自2002年推出肾脏病结果质量倡议(KDOQI)分类以来,CKD的披露和管理,倡导针对更新后的肾脏病:改善全球结果(KDIGO)2024临床指南采用新的方法.过去二十年来,英国CKD护理的改善是国际上采用KDIGO分类系统的基础。混合采用循证治疗和研究为临床指南和政策提供了依据。临床和学术界对证据的解释引发了关于如何最好地实施这些证据的重大辩论,这些证据经常推动并令人沮丧地阻碍了CKD护理的进展。有效CKD护理的关键推动者包括临床分类系统(KDIGO),循证治疗,电子健康记录工具,经济激励式护理,医学教育和政策变化。有效CKD护理的障碍是广泛的;关键障碍包括临床医生对过度诊断的担忧,初级保健缺乏经济激励,复杂的临床指南,在多发性疾病的背景下管理CKD,初级保健的官僚负担,钠-葡萄糖协同转运蛋白-2抑制剂(SGLT2i)药物利用不足,CKD医学教育不足,最近-在COVID-19大流行期间和之后,常规CKD护理持续中断。英国初级保健的未来CKD护理必须借鉴过去二十年的经验教训。做出改变,在规模上逐步改善CKD护理需要一种新的方法来解决检测的关键障碍,诊断,跨越传统医疗保健边界的披露和管理,社会关怀,和公共卫生。提高了初级保健中的编码精度,增加SGLT2i药物的使用,和基于风险的护理提供有希望的,改善患者和人群肾脏健康的具有成本效益的途径。财务激励措施通常会提高护理质量指标的实现-迫切需要对CKD护理中的财务和非财务激励措施进行审查。
Chronic kidney disease (CKD) is a global public health problem with major human and economic consequences. Despite advances in clinical guidelines, classification systems and evidence-based treatments, CKD remains underdiagnosed and undertreated and is predicted to be the fifth leading cause of death globally by 2040. This review aims to identify barriers and enablers to the effective
detection, diagnosis, disclosure and management of CKD since the introduction of the Kidney Disease Outcomes Quality Initiative (KDOQI) classification in 2002, advocating for a renewed approach in response to updated Kidney Disease: Improving Global Outcomes (KDIGO) 2024 clinical guidelines. The last two decades of improvements in CKD care in the UK are underpinned by international adoption of the KDIGO classification system, mixed adoption of evidence-based treatments and research informed clinical guidelines and policy. Interpretation of evidence within clinical and academic communities has stimulated significant debate of how best to implement such evidence which has frequently fuelled and frustratingly forestalled progress in CKD care. Key enablers of effective CKD care include clinical classification systems (KDIGO), evidence-based treatments, electronic health record tools, financially incentivised care, medical education and policy changes. Barriers to effective CKD care are extensive; key barriers include clinician concerns regarding overdiagnosis, a lack of financially incentivised care in primary care, complex clinical guidelines, managing CKD in the context of multimorbidity, bureaucratic burden in primary care, underutilisation of sodium-glucose co-transporter-2 inhibitor (SGLT2i) medications, insufficient medical education in CKD, and most recently - a sustained disruption to routine CKD care during and after the COVID-19 pandemic. Future CKD care in UK primary care must be informed by lessons of the last two decades. Making step change, over incremental improvements in CKD care at scale requires a renewed approach that addresses key barriers to
detection, diagnosis, disclosure and management across traditional boundaries of healthcare, social care, and public health. Improved coding accuracy in primary care, increased use of SGLT2i medications, and risk-based care offer promising, cost-effective avenues to improve patient and population-level kidney health. Financial incentives generally improve achievement of care quality indicators - a review of financial and non-financial incentives in CKD care is urgently needed.