淺談慢性腎臟病

Overview of Chronic Kidney Disease

林偉弘(Wei-Hung Lin) ； 郭冠良(Kuan-Liang Kuo) ； 夏清智(Ching-Chih Hsia) ； 吳岱穎(Tai-Yin Wu) ； 陳建志(Chien-Chih Chen)

《北市醫學雜誌》 10卷2期 (2013/06) Pp. 101-109

https://doi.org/10.6200/TCMJ.2013.10.2.01

摘要

慢性腎臟病早期並無明顯症狀，通常難以察覺。在台灣，末期腎臟病之盛行率為世界第一，但病人的自我認知率卻是相當低，以致於錯失了治療先機。進展至末期腎臟病之病人常常需要終身洗腎，我國全民健保每年花費超過300億元給付洗腎相關費用，實質上對國家財政已經造成重大負擔。欲改善此狀況，有賴基層醫師對高危險群民眾之積極篩檢及早期介入（次段預防），政府應該讓社會大眾對慢性腎臟病更加認識與了解（初段預防）。臨床醫師篩檢時，宜使用簡化版的MDRD（Modification of Diet in Renal Disease）公式與尿液白蛋白與肌酐酸之比值來評估腎臟健康狀況。若診斷為早期慢性腎臟病，則須積極控制潛在疾病以延緩腎臟疾病之惡化。隨著疾病進展，如有無法控制的併發症或病程已經進入第四期，甚至是末期時，宜轉介腎臟專科醫師進行評估和治療或考慮腎臟替代療法，以改善末期腎臟病病人之生活品質。

關鍵字

慢性腎臟病 ； 腎絲球過濾率 ； 蛋白尿

並列摘要

It is difficult to detect early stage chronic kidney disease (CKD) since there are no obvious symptoms. The prevalence of end stage renal disease (ESRD) in Taiwan is the highest in the world. However, the CKD awareness rate is so low that most patients are not treated at an early stage. Patients who progressed to ESRD need lifelong dialysis. The Taiwanese National Health Insurance spends more than 30 billion NT$ on dialysis alone each year, which is a major financial burden on the country. To solve this problem, primary care physicians should actively screen the Taiwanese population who are at high risk and intervene accordingly. The government should improve public awareness and understanding of CKD. Clinicians can use both the Abbreviated Modification of Diet in Renal Disease (MDRD) formula and the albumin/creatinine ratio to screen for abnormal renal function. If early stage of CKD is diagnosed, aggressive treatment of the underlying disease is indicated to prevent deterioration of kidney function. As the disease develops, there may be uncontrollable complications or progression into CKD stage 4. In order to improve the quality of life of ESRD patients, referral to nephrologist for renal replacement therapy is indispensable.

並列關鍵字

chronic kidney disease ； glomerular filtration rate ； proteinuria