Research On Community Screening Of High-risk Population Of Chronic Kidney Disease In Shanghai

ObjectiveWith the change of disease spectrum,noninfectious chronic diseases such as diabetes,hypertension,cardiovascular and cerebrovascular diseases have become a significant threats to human health.Moreover,kidney diseases and noninfectious chronic diseases are found to be closely correlated.On one hand,Chronic Kidney Disease(CKD)increases the incidence of diabetes,hypertension and cardiovascular and cerebrovascular diseases;on the other hand,these diseases put an additional burden on the kidney,causing damage to the kidney function and raising the possibility of CKD.Therefore,the prevention of traditional chronic diseases must be accompanied by increased attention to the CKD(including end-stage renal disease).There are six stages of CKD which starts with a normal or high Glomerular Filtration Rate(GFR);it then leads to a Mild CKD,a Moderate CKD and then a Severe CKD with a further decline in the GFR,and finally,End Stage CKD or death.Fortunately,CKD can be prevented and controlled.At all stages of CKD development,effective interventions can be made to delay or even reverse the progress of the disease.Therefore,early screening of CKD is particularly important.This paper is based on Systemic Redesign and Demonstration for Early Detection,Evaluation and Management of Chronic Kidney Disease in Shanghai.The paper analyzes the disease situation of CKD in high-risk population,and compares the differences between screened patients and known chronic kidney patients in terms of disease stage and risk stratification.By comparing the difference of CKD detection rate among high-risk groups with different age,gender,disease history and risk factors,this paper provides a customized screening program based on regional characteristics in additional to the existing factors.MethodsThe data were collected from Systemic Redesign and Demonstration for Early Detection,Evaluation and Management of Chronic Kidney Disease in Shanghai,for which researchers carried out the screening of high-risk population of chronic kidney disease in community health service centers in Jing'an and Minhang districts of Shanghai.According to the CKD diagnostic criteria published by the KDOQI working group,the target population took two laboratory tests at an interval of more than 3months.Suspected patients with two positive laboratory tests were sent to district hospitals for diagnosis and stratification of disease staging and risk.The screening subjects were divided into groups according to their gender,age,medical history and risk factors.The differences in the CKD detection rate of each group were used by researchers to optimize the screening process.ResultsSenior women account for 47.05%of the total test population.They also have more complex medical histories than other groups:the percentage of people having history of hypertension is the highest(61.77%);as for types of risk factors,the high-risk population with two risk factors accounts for the largest proportion(44.01%).The detection rate of CKD in community high-risk population of chronic kidney disease is 14.71%.Early CKD patients accounts for the majority(84.57%).The detection rate of CKD in women at high risk is higher than that in men(?~2=202.158,P<0.001).The detection rate of CKD in the elderly is higher than that in the non-elderly(?~2=16.294,P<0.001).The detection rate of CKD in people with hypertension is higher than that in people without hypertension(?~2=67.837,P<0.001).The detection rate of CKD in people with four risk factors(21.41%)is higher than that in other groups.By multivariate regression analysis,researchers found that female,age and having history of hypertension were positively correlated with CKD.Conclusions and recommendationsIn conclusion,community screening of people at high risk for CKD were able to identify potential CKD patients and most of the patients identified were at the early stage of CKD.Among high-risk groups,there were differences in CKD detection rates among groups with different genders,ages,medical histories and risk factors.According to the test result,it is highly recommended that we should prioritize the screening for high-risk groups with three or more risk factors.We should then proceed to test patients who are senior,have high blood pressure and two risk factors.Last,for high-risk groups with only one risk factor,we should screen elderly people or those with high blood pressure first.If condition permits,we can expand the screening scope.