Investigation And Study Of Chronic Kidney Disease Based On The Community Health Service Center In The Main Urban Area Of Kunming Yunnan

ObjectivesChronic non communicable diseases(NCD)is a global public health problem in the 21st century.Chronic kidney disease(CKD)is a serious public health challenge to the family,society and the country because of its hidden onset,serious complications,huge consumption of medical resources and low quality of life.In China,the prevalence of CKD is 10.8%.High prevalence of CKD and high risk of CKD with cardiovascular disease.Especially in the early stage of CKD,there is a lack of effective early identification and management.Under the guidance of the "healthy China 2030" plan,combined with the management of chronic diseases(hypertension and diabetes)in the community,and based on the community health service center,CKD related surveys were conducted among community residents.The purpose of this study is to provide evidence for the management of CKD in community health service centers and provide strategies for the prevention and control of CKD.MethodsFirst of all,based on the community health service center,aiming at all the macro population in the community,by using the methods of questionnaire and physical examination,investigated the CKD related situation of the community residents within the service scope of the community health service center in the main urban area of Kunming City,Yunnan Province.To further understand the risk factors,awareness,utilization of community health services,health needs of CKD and health literacy of residents.Secondly,a cross-sectional epidemiological survey of CKD was carried out among the chronic patients(hypertension and diabetes)in the community health service center of the main urban area of Kunming.The prevalence of CKD was detected by questionnaire,test of renal function,urine routine test,early urinary renal injury.Investigated the management of chronic patients by using PAM-13 questionnaire.Then the prevalence and epidemic characteristics of CKD in chronic patients(hypertension and diabetes mellitus)were obtained.Thirdly,five SNP gene polymorphisms of PVT1 were analyzed in different patients.It is further clarified that the molecular epidemiology of PVT1 in the residents of Kunming City,Yunnan Province.Finally,based on the first three parts of data,four kinds of CKD risk assessment and prediction models based on community health service center were established by mechanical learning,and 13 indicators were found to play a major role in the establishment of the model.ResultsIn the first part,it is found that the community residents have high demand for CKD and risk factors for CKD,and the awareness rate of CKD is low,especially in the chronic disease population.And there is a contradiction between the supply and demand of CKD between the community health service center and residents.Especially in the high-risk group of chronic CKD(hypertension,diabetes),the residents' personal health literacy is good,but the actual residents' health efficacy evaluation is low.The demand of CKD management is higher in chronic patients.In the second part,we found that the prevalence of CKD was 42.6%in the residents of community health service center.It was found that high uric acid,male and obesity were risk factors for CKD.By detecting Albumin-to-creatinine,the positive rate of abnormal albuminuria was 37.0%.The positive rate of eGFR decrease was different by using the Chinese modified MDRD formula,2009 CKD-EPI formula and 2012 CKD-EPI cystatin C formula.Through the analysis of different groups of chronic patients with PAM13,we found that there were differences in their patient activation for the disease.Community care and patients' self-improvement were needed.In the third part,it was found that there was no significant difference in 5 SNPs of PVT1 gene in among the residents in Kunming.But it may be the influencing factor of CKD progress.In the fourth part,based on the data of the first three parts,the prediction model of CKD risk assessment 4 based on community health service center is established by machine learning.It is found that 13 indicators play a major role in the establishment of the model.It is necessary to pay more attention to these 13 indicators of residents and identify CKD earlier.ConclusionsBased on the existing conditions and resources of community health service centers in Kunming City,it is necessary to carry out CKD prevention and control for residents with different risks in the community.It is suggested that CKD management should be set up in community health service center and CKD prevention should be done well.It is suggested to carry out early CKD screening for community chronic patients(patients with diabetes and hypertension),and to detect urinary microalbumin in these groups,so as to improve the awareness of doctors and nurses for early screening of CKD,and to provide more early prevention and treatment intervention for chronic disease patients managed by the community.To establish and implement a convenient and practical early diagnosis model for community CKD.To improve the community residents' awareness of CKD and early detection of CKD patients.To provide the theoretical basis and strategy of three-level prevention management for CKD management of community health service center residents.