Chronic kidney disease
Seminar www.thelancet.com Vol 379 January 14, 2012
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Seminar
www.thelancet.com Vol 379 January 14, 2012 177 programmes for kidney disease have been launched in many locations, which confi rm a high prevalence of decreased GFR and albuminuria in association with a high burden of risk factors for cardiovascular disease. 140 However, studies 141–144 have suggested that screening is not cost eff ective for reducing kidney failure or all-cause mortality except in high-risk populations—eg, old people with diabetes or hypertension. With a wide range of outcomes and a focus on high-risk target populations, cost-eff ectiveness of screening might be improved. Chronic kidney disease is one of several chronic diseases aff ecting mostly older people and leading to a substantially increased risk of cardiovascular disease. Coordination of public health eff orts for chronic kidney disease and other chronic diseases will probably be the most effi cient strategy. Reorganisation of delivery of care to treat older people and others with various chronic diseases effi ciently will probably be necessary, as will cooperation at all levels of governmental and private organisations. Assessment of the eff ectiveness of public health strategies will be important to guide progress. Contributors ASL did the literature search and wrote the fi rst draft of the Seminar with assistance from JC. Both authors interpreted the retrieved publications and planned and revised the Seminar. Confl icts of interest ASL has received payment for editorial board membership from the National Kidney Foundation (NKF), and grant support from NKF and Amgen. JC declares that he has no confl icts of interest. Acknowledgments We thank Mark J Sarnak, Katrin L Uhlig, Lesley A Stevens, Ashish Upadhyay, and Joe Eustace for reviewing early versions of the Seminar; Aghogho Okparavero for helping to prepare the Seminar; and Stephen Juraschek and Brad C Astor for providing data for fi gure 4. References 1 National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classifi cation, and stratifi cation. Am J Kidney Dis 2002; 39 (2 suppl 1): S1–266. 2 Levey AS, Coresh J, Balk E, et al, for the National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classifi cation, and stratifi cation. Ann Intern Med 2003; 139: 137–47. 3 Levey AS, Eckardt KU, Tsukamoto Y, et al. Defi nition and classifi cation of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089–100. 4 Levey AS, Stevens LA, Coresh J. Conceptual model of CKD: applications and implications. Am J Kidney Dis 2009; Download 353.83 Kb. Do'stlaringiz bilan baham: |
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