慢性肾脏病诊治新常态.ppt

慢性肾脏病诊治新常态
人类社会的发展成就与挑战
世界的城市化进程
糖尿病和高血压:导致ESRD主要原因
进入透析的患者的初步诊断分类
Diabetes
%
Hypertension
27%
Glomerulonephritis
13%
Other
10%
United States Renal Data System. Annual data report. 2000.
No. of patients
Projection
95% CI
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0
100
200
300
400
500
600
700
R2=%
243,524
281,355
520,240
No. of dialysis patients
0 600 1200 1800 2400
Rate per million population
Taiwan
United states
Japan
Shanghai
Turkey
Korea
HK
Germany
Finland
prevalence of ESRD ,2007
2,288
2,060
1,698
1,114
1,037
1,027
973
690
447
420
USRDS 2009
Canada
Thailand
Malaysia
Chinese Society of Blood Purification(CSBP)  ESRD Registration Program
End of 2007 End of 2008
ESRD patients 65,047 102,863
On HD/PD
Point
prevalence
%
Zou L and wang M for the Chinese Society of Blood Purification
Clinical Nephrology,-
27/31(87%)provinces responded to this survey
There were big regional&provincial differences
China:ESRD Growth Rate to Exceed That of Population
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
ACTUAL
PROJECTED
%per year
population
-%per year
ESRD patients
300,000
250,000
200,000
150,000
100,000
50,000
0
1,150,000,000
1,200,000,000
1,250,000,000
1,300,000,000
1,350,000,000
1,400,000,000
1,450,000,000
Total pappulation
ESRD patients
Smith DH et al. J Am Soc Nephrol. 2004;15:1363.
Collins AJ et al. Am J Kidney Dis. 2008; 51: S1
CKD医疗费用巨大
美国CDK的医疗人群,占医疗总预算的24%。
中国一位尿毒症透析患者,一年的医疗费10万元。
尿毒症患者,只是CKD患者的冰山一角。
CKD患者的医疗费用??
2009 KDIGO伦敦研讨会:Prognosis Matters
tings_events/
——Andrew S. Levey, MD
波士顿塔夫茨新英格兰医学中心肾脏科主任、教授
NKF临床实践指南发展和执行中心主席
KDIGO 2009伦敦研讨会计划委员会主席
KDOQI 2004CKD高血压和降压药物指南工作组主席
KDOQI 2002CKD临床实践指南工作组主席
2002 从 DOQI 到 KDOQI指南: 从终末期肾病到CKD全程管理
National Kidney