Ntu 2: Cov Kws Khomob Thawj Saib Xyuas Kev Pom Zoo Ntawm Cov Teeb Meem Thiab Cov Kws Pabcuam Rau Kev Tswj Xyuas Kabmob Raum Hniav: Ib Txoj Kev Kawm Sib xyaw

Rau Part 1, thov niasHERE.

Systems-theem teeb meem rau CKD tswj

Tsis tas li ntawd, PCPs ntseeg tias qhov tsis muaj txiaj ntsig hauv kev saib xyuas kev noj qab haus huv cuam tshuam rau kev tswj hwm CKD. Cov kev cov nyom no suav nrog lub sijhawm tsis txaus rau kev tswj hwm cov txheej txheem kab mob nyuaj xws li CKD hauv cov neeg mob uas feem ntau muaj teeb meem kev kho mob, nrog rau kev them nyiaj tsawg, cov ntaub ntawv kho mob hauv hluav taws xob tsis zoo (EMR) cov qauv, thiab cov kev pab kho mob tsis txaus thiab cov peev txheej. PCPs tsom hnyav rau lub sij hawm txwv nyob rau hauv ib txoj kev kho mob uas tsis zoo rau kev tswj cov neeg mob uas muaj ntau yam kab mob, los yog kev tswj cov txheej txheem kab mob ntau yam xws li CKD. Raws li kev saib xyuas ntawm tus neeg mob CKD xav tau kev kawm rau tus neeg mob thiab kev tswj hwm kev kub siab, ntshav qab zib, ntshav ntshav, thiab lwm yam kab mob sib kis lossis kev txhawj xeeb hnyav, feem ntau tsis txaus sijhawm nyob rau hauv tsev kho mob mus ntsib txhua yam kev kho mob thiab kev coj tus cwj pwm. Yog li, nws yog ib qho yooj yim rau deprioritize CKD los yog ncua kev tswj kom txog thaum lwm tus mus ntsib:

"Kuv xav tias thaum lub sijhawm 15 lossis 20 feeb koj muaj nrog tus neeg mob teem sijhawm, koj cov txheej txheem ntev. Koj yuav tsum tau nrog lawv cov ntshav siab thiab ntshav qab zib thiab lawv tuaj yeem tuaj vim lawv lub nraub qaum mob lossis lwm yam."

"Tus neeg mob tsis muaj tsos mob, tus neeg mob yuav tsis yws txog nws [CKD], yog li koj txhawj xeeb txog mob caj pas rau ib hnub lossis cov roj cholesterol thiab lwm yam."

PCPs tau txheeb xyuas qhov kev them rov qab tsis txaus yog qhov cuam tshuam rau kev saib xyuas zoo dua. Thaum lawv tau sau tseg tias muaj nyiaj rov qab ntau dua rau kev mus ntsib ntau zaus, qhov tsis muaj sijhawm teem sijhawm tau pom tias yog qhov txwv tsis pub. Ntxiv rau, PCPs tau qhia tias tsis yog txhua lub chaw soj nstuam tau tshaj tawm eGFR los pab txhawb kev lees paub ntawm CKD; EMR systems tsis tau kho kom zoo rau kev tswj kab mob ntev; tsis muaj kev kawm txaus (piv txwv li, cov ntaub ntawv qhia kev kawm rau cov neeg mob tsis hais lus Askiv), thiab ntau yam kev coj ua tsis muaj tus kws kho mob txuas ntxiv los pab txhawb kev saib xyuas ntev thiab kev kawm rau cov neeg mob.

cistanche can treat kidney disease

Cistanche yog qhov zoo rau lub raum ua haujlwm

Cov neeg pab tswv yim ntawm CKD kev tswj hwm

Cov neeg teb xov tooj kuj tau thov ntau tus neeg pab tswv yim los daws cov teeb meem no rau kev tswj hwm CKD. PCPs xav tau kev txhawb nqa kev txiav txim siab (xws li, cov lus ceeb toom hauv hluav taws xob nrog EMR lossis chaw kuaj mob), tsis siv neeg eGFR qhia los ntawm txhua lub chaw soj nstuam, kev saib xyuas pab pawg muaj zog dua, cov lus qhia meej thiab meej CKD, nce nyiaj ntxiv, thiab kev pov hwm zoo dua rau CKD saib xyuas cov haujlwm, thiab CKD cov cuab yeej kev kawm zoo dua los pab tswj CKD. PCPs xav tias nws yuav pab tau kom muaj kev tshoov siab rau hauv lawv qhov kev coj ua txhua hnub kom ceeb toom lawv txog CKD cov haujlwm saib xyuas. Rau PCPs uas muaj kev txiav txim siab txhawb nqa hauv lawv EMR lossis los ntawm kev sau ntawv qhia uas nrog rau kev kuaj xyuas, lawv pom tias nws muaj txiaj ntsig zoo hauv kev pab txhawb CKD kev saib xyuas raws li cov lus qhia. Tus PCP tau piav qhia,

"Peb EMR muaj ntau qhov pop-ups uas qhia meej tias yuav xaj dab tsi thiab qhov ntawd pab tau."

PCPs kuj tau xav tias kev tshaj tawm eGFR automated tau txhim kho lawv txoj kev paub txog CKD, thiab xav tias nws tseem ceeb uas txhua lub chaw soj nstuam qhia txog eGFR thaum creatinine raug txiav txim.

PCPs xav tau kev siv ntau dua ntawm pab pawg saib xyuas kev noj qab haus huv ntau dua, xws li cov kws kho noj zaub mov, cov neeg saib xyuas cov ntaub ntawv, kws muag tshuaj, thiab cov kws qhia noj qab haus huv los pab txhawb cov neeg mob kev kawm thiab kev tswj tus kheej ntawm cov xwm txheej pheej hmoo rau kev nce qib CKD. Cov PCPs uas tau nkag mus rau cov peev txheej no pom tias lawv muaj txiaj ntsig zoo:

"Nws pab thaum peb hloov pauv ntau dua rau kev tswj hwm pej xeem thiab muaj txiaj ntsig tshaj qhov ntim-tsev kho mob raws li tus qauv dhau los ua qhov tseem ceeb hauv kev tswj hwm kab mob ntev."

Cov neeg teb xov tooj ntseeg tau npaj nkag mus kom meej thiab meejMob raum mobxav tau cov lus qhia, suav nrog rau kev nyuaj ntxivnephrologyCov ntsiab lus xws li electrolytes thiab metabolic acidosis:

"Yog tias nws yog cov lus qhia ua tau tiag tiag - uas kuv tsis tau pom tus kheej - los tswj cov teeb meem electrolyte, kuv xav tias yuav pab tau zoo kawg."

Tsis tas li ntawd, txhim kho kev them nyiaj rov qab rau CKD cov haujlwm saib xyuas thiab ua kom zoo ntawm kev tuav pov hwm nrog cov txheej txheem kho mob kom tshem tawm cov teeb meem nyiaj txiag rau cov neeg mob tau suav tias yog qhov tseem ceeb rau kev noj qab haus huv CKD:

"Kuv xav tias yog tias peb tau txais txiaj ntsig zoo dua rau kev tswj hwm cov teeb meem nyuaj no peb tuaj yeem siv sijhawm ntau nrog tus neeg mob thiab nws yuav tsis yog qhov nyuaj heev ... "

"Kuv pom tsis ntev los no, thiab tej zaum 10-15 xyoo dhau los, cov ntawv pov hwm kev tuav pov hwm yeej ua rau cov lus qhia kho mob. Thiab nws tsis muaj hmoo, tab sis koj tsis tuaj yeem tawm tsam lawv, thiab koj tsis tuaj yeem piav qhia rau cov neeg mob - qhov no yog qhov nephrologist lub koom haum hais, tab sis qhov no yog li koj daim ntawv faj seeb hais, koj mus qhov twg los ntawm no?

PCPs kuj xav tau kev kawm ntxiv los txhim kho lawv txoj kev nkag siabMob raum mobkev tswj hwm (piv txwv li, cov cuab yeej hauv web thiab / lossis cov haujlwm CME) nrog rau kev nkag tau ntau dua thiab siv cov cuab yeej kev kawm zoo los pab txhawb kev kawm CKD rau tus neeg mob. Thaum kawg, tsa kev paub txogMob raum mobnyob rau hauv cov pej xeem sawv daws tau ntseeg tias tseem ceeb."Ntau tshaj tawm xov xwm"thiab"txawm tias kev tshaj tawm kev pabcuam pej xeem"Tej zaum yuav ua rau cov neeg mob muaj kev koom tes hauv lawv txoj kev tswj hwm CKD, thiab qhov no yuav ua kom yooj yim ntxiv los ntawm kev txiav txim siab mus ntsib tshwj xeeb rau CKD kev sib tham.

Hauv kev sib piv cov PCPs cov lus teb rau daim ntawv nug nrog cov ntsiab lus uas tau pom nyob rau hauv kev sib tham hauv pab pawg, qhov kev tshawb pom zoo sib xws. Hauv ob daim ntawv nug thiab cov pab pawg tsom xam, cov kws kho mob qhia txog qhov tsis muaj kev paub thiab kev paub txog CKD cov lus qhia, tsis muaj kev nplij siab nrog kev tswj hwm CKD (tshwj xeeb yog cov teeb meem ntsig txog CKD), thiab tsis muaj peev txheej los pab txhawb kev tswj hwm ntawm CKD lossis txhim kho cov neeg mob. Kev tswj tus kheej ntawm lawv cov kev pheej hmoo rau kev nce qib CKD. Tsis muaj kev sib cav pom tseeb ntawm daim ntawv nug thiab cov kev tshawb pom ntawm pawg neeg tsom xam; Txawm li cas los xij, pawg tsom xam tau muab kev nkag siab ntau dua ntawm cov teeb meem uas cov kws kho mob tau ntsib. Piv txwv li, thaum feem coob ntawm cov kws kho mob tau tshaj tawm tias muaj kev txaus siab nrog kev kuaj mob ntawm CKD (94 feem pua) ntawm daim ntawv nug, hauv cov pab pawg tsom mus, PCPs tau tshaj tawm cov kev sib tw nrog cov kauj ruam uas yuav tsum tau ua kom muaj kev saib xyuas zoo xws li ntsuas qhov hnyav ntawm CKD lossis muab nws tso rau hauv daim ntawv teev cov teeb meem kom nws thiaj li tuaj yeem hais tau txhua lub sijhawm thaum mus ntsib tom ntej. Ib tus kws kho mob tau hais tias:

"Kuv paub qhov kev kuaj mob yog dab tsi. Qhov kev sib tw yog theem twg yog qhov no lossis sau cov ntaub ntawv kuaj mob."

Kev sib tham

Hauv txoj kev tshawb no, PCPs tau txheeb xyuas ntau yam teeb meem los muab kev saib xyuas CKD kom zoo, suav nrog tus neeg mob- (xws li cov neeg mob kev nkag siab tsis txaus ntawm CKD thiab kev ua raws li qhov tsis txaus siab rau kev kho mob pom zoo), tus kws kho mob- (xws li PCPs tsis tshua paub txog CKD cov lus qhia, nyuaj rau kev tswj kev pheej hmoo. yam tseem ceeb rau CKD kev vam meej, thiab kev ntseeg tias lawv tsis tuaj yeem txhim kho CKD), thiab cov txheej txheem-theem (xws li, txwv sij hawm mus saib xyuas cov neeg mob nyuaj, tsis muaj cov ntaub ntawv kho mob dav dav los taug qab thiab npaj kev saib xyuas; thiab tsis muaj peev txheej los txhawb tus neeg mob. kev tswj tus kheej ntawm lawvMob raum mobkev pheej hmoo) barriers. Lawv kuj tau txheeb xyuas cov kws pab tswv yim uas tuaj yeem muab kev daws teeb meem rau qee yam ntawm cov teeb meem no (xws li, cov lus qhia meej meej thiab cov txheej txheem, kev txiav txim siab txhawb kev koom ua ke hauv EMR, thiab kev saib xyuas hauv pab pawg).

Cov kev tshawb pom los ntawm qhov kev tshawb fawb no yog ua raws li lwm cov kev tshawb fawb uas tau siv ntau txoj hauv kev (xws li, daim ntawv nug, kev tshuaj xyuas cov ntaub ntawv kho mob, kev xam phaj, lossis pab pawg tsom xam) los qhia txog PCPs 'cov qauv kev coj ua thiab txheeb xyuas cov teeb meem rau kev tswj hwm ntawm CKD los ntawm PCPs.[9, 11, 13, 16–23] Txawm li cas los xij, muaj qee qhov kev tshawb fawb uas tshawb nrhiav qhov tob tob txog qhov ua rau tsis muaj txiaj ntsig.Mob raum mobKev saib xyuas los ntawm US PCPs, uas muaj kev paub dhau los hauv kev xa CKD kev saib xyuas yuav txawv ntawm lwm lub teb chaws uas muaj kev saib xyuas kev noj qab haus huv thoob ntiaj teb.[9, 13, 16] Txoj kev tshawb no tsim los ntawm cov pov thawj uas twb muaj lawm los muab cov ntsiab lus ntxaws txog cov teeb meem US PCPs kev paub txog kev saib xyuas cov neeg mob. nrog CKD. Cov kev tshawb pom los ntawm txoj kev tshawb fawb no muab cov kev pom muaj txiaj ntsig zoo uas tuaj yeem siv los txhim kho kev xa khoom ntawm CKD kev saib xyuas hauv kev saib xyuas thawj zaug hauv Teb Chaws Asmeskas, thiab qhov ntawd kuj tseem tuaj yeem ua rau PCPs xyaum ua lwm lub teb chaws lossis saib xyuas lwm yam.

Cov neeg mob-theem teeb meem uas tau txheeb xyuas los ntawm PCPs hauv peb txoj kev tshawb fawb suav nrog kev paub thiab kev nkag siab ntawm CKD, kev ua tsis tiav rau cov lus pom zoo kho mob, thiab cov nqi kho mob. Cov kev tshawb pom no zoo ib yam nrog cov kev tshawb fawb ua ntej piav qhia cov neeg mob kev nkag siab tsis zoo ntawm CKD thiab nws qhov cuam tshuam txog kev noj qab haus huv.[24–28] Lub ntsiab lus tseem ceeb ntawm cov tshuaj niaj hnub no yog qhia cov neeg mob tau txais txiaj ntsig kev noj qab haus huv zoo dua.[29] Hauv CKD, txawm li cas los xij, cov kev tshawb fawb tau pom tias kev paub txog CKD ntawm cov neeg mob tsis tshua muaj feem cuam tshuam rau lwm yam kab mob xws li ntshav qab zib lossis ntshav siab.[24–28] CKD yog lub tswv yim nyuaj rau cov neeg mob kom nkag siab, thiab kev tswj xyuas zoo feem ntau xav tau nyiaj txiag tseem ceeb. cov nqi thiab cov kev hloov pauv loj rau kev noj zaub mov thiab kev ua neej kom txo tau cov kev pheej hmoo rau kev nce qib CKD.[30, 31] PCPs tuaj yeem ua lub luag haujlwm tseem ceeb hauv kev txhim kho cov neeg mob CKD kev paub thiab kev tswj tus kheej. Txawm hais tias feem ntau ntawm PCPs hauv peb txoj kev tshawb fawb tau qhia tias muaj kev txaus siab rau kev qhia cov neeg mob txog CKD, ntawm kev nug ntxiv lawv tau hais txog cov teeb meem hauv kev txhim kho cov neeg mob kev nkag siab txog lawv qhov kev kuaj mob CKD thiab koom nrog lawv hauv kev pheej hmoo hloov pauv. Cov kev tshawb pom no hais txog qhov yuav tsum tau muaj kev tshaj tawm ntau dua ntawm cov cuab yeej thiab cov peev txheej los pab txhawb cov neeg mob kev kawm txog CKD thiab txhim kho cov neeg mob kev nkag siab txog CKD txaus ntshai.[32] Txuas kev kawm CKD rau lwm cov kev kho mob uas muaj nyob, xws li ntshav qab zib thiab kub siab, tuaj yeem txhim kho cov neeg mob kev paub txog CKD thiab tseem pab txhawb kev xa khoom ntawm CKD kev kawm ntau ntxiv thaum mus ntsib kws kho mob..[27] Kev nkag mus tau zoo dua rau kev txhawb nqa kev tswj tus kheej zoo hauv kev saib xyuas thawj zaug (xws li kev tswj hwm rooj plaub, kev pabcuam kev noj qab haus huv hauv zej zog, kev xa mus rau cov pov thawj-raws li kev tswj hwm tus kheej cov kev kawm, kev qhia tus neeg saib xyuas thiab kev txhawb nqa) yuav tsum yog

Ib qho tseem ceeb ntawm cov tswv yim nrhiav kev txhim kho cov neeg mob CKD kev paub, kev ua raws li kev kho mob, thiab kev ua tiav ntawm CKD cov hom phiaj kev saib xyuas.[33–35] Thaum cov kev cuam tshuam no tau ua pov thawj ua tiav hauv lwm cov kab mob, kev sim tsis ntev los no ntawm tus neeg mob navigators thiab txhim kho cov ntaub ntawv kho mob ntawm tus kheej hauv CKD ua tsis tau tejyam qhia tau hais tias muaj feem cuam tshuam rau ntau yam CKD tshwm sim.[36] Txoj kev tshawb no, txawm li cas los xij, tej zaum yuav tsis muaj zog thiab cov neeg mob uas muaj kev pheej hmoo siab tsis tau tsom tshwj xeeb. Kev ua haujlwm ntxiv hauv cheeb tsam no yog xav tau.

Echinacoside of cistanche can improve kidney function

PCPs hauv peb txoj kev tshawb fawb kuj tau txheeb xyuas ntau yam ntawm lawv tus kheej cov teeb meem hauv kev saib xyuas cov neeg mob CKD, suav nrog kev paub txog CKD tsawg, tsis tshua paub txog CKD cov lus qhia, thiab nyuaj rau kev tswj xyuas qhov nyuaj ntawm ntau yam kab mob sib kis. Kev ntseeg tias CKD yog kho tsis tau kuj tseem tuaj yeem txhawb nqa cov teeb meem no.Nephrologyfeem ntau raug suav hais tias yog thaj chaw nyuaj los ntawm cov tub ntxhais kawm uas nrhiav kev cob qhia subspecialty hauv kev qhuab qhia uas tsis yogNephrology. ib lub sij hawm thaum lubKab mob raumCov txiaj ntsig Kev Ua Haujlwm Zoo (K/DOQI) cov lus qhia tau luam tawm rau 5 xyoos.[40] Txij thaum ntawd los, K / DOQI cov lus qhia feem ntau tau hloov los ntawm ntau cov ntaub ntawv pom zoo ntev los ntawmKab mob raumTxhim kho Cov txiaj ntsig thoob ntiaj teb (KDIGO) koom nrog. KDIGO cov lus qhia yog tsom rau cov kws kho mob nephrologist, thiab tsis yog qhov xav tsis thoob, kev siv zog los ntawm PCPs tau txwv hauv Tebchaws Meskas thiab lwm qhov. ua raws li CKD cov lus qhia. Tsis tas li ntawd, feem ntau ntawm cov PCPs hauv peb txoj kev tshawb fawb tau tshaj tawm tias nws xis nyob tswj lawv cov neeg mob nrog CKD, tab sis tsis xis nyob tswj hwm CKD-txuas nrog cov teeb meem (xws li, metabolic acidosis, pob txha, lossis ntshav ntshav). Qhov no qhia tau hais tias PCPs tuaj yeem yooj yim nrog lub hauv paus ntawm kev tswj cov neeg mob nrog CKD tab sis tsis tshua npaj tau zoo los siv cov kev qhia tshwj xeeb.

Cov lus qhia meej thiab meej CKD yog xav tau los pab txhawb kev siv ntau dua los ntawm PCPs. Txhawm rau pab daws CKD kev paub tsis meej thiab txhawm rau kom paub txog thiab siv CKD cov lus qhia, ob qho tib si National Kidney Foundation (NKF) thiab American College of Physicians tau luam tawm CKD algorithms tsom rau PCPs.[43, 44] Tsis tas li ntawd, NKF tau tshaj tawm CKDinform. , cov ntaub ntawv pov thawj-raws li cov peev txheej thiab cov txheej txheem, los qhia PCPs txog kev coj ua zoo tshaj plaws hauv kev tswj hwm CKD thaum ntxov.[45] Kev tshaj tawm ntau dua thiab kev txhawb nqa ntawm cov peev txheej no hauv kev saib xyuas thawj zaug thiab txhim kho kev kawm ntxov ntawm cov kws kho mob thawj zaug hauv cov ntsiab lus tseem ceeb ntawm kev tswj hwm CKD tuaj yeem txhim kho PCPs kev qhia txog kev saib xyuas-kev sib raug zoo CKD.[9] Tsis tas li ntawd, txij li PCPs feem ntau saib xyuas cov neeg mob uas muaj ntau yam mob, cov tswv yim no yuav tsum ua kom sib haum xeeb cov hom phiaj kev kho mob tsis sib haum xeeb thaum tswj CKD nyob rau hauv cov ntsiab lus ntawm ntau yam mob. Kev tawm tsam cov hom phiaj kho mob tuaj yeem ua rau muaj kev pheej hmoo tuag, mus pw hauv tsev kho mob, thiab chaw saib xyuas xwm txheej ceev hauv cov pej xeem no.[46]

Tsis tas li ntawd, cov txheej txheem-theem teeb meem rau PCPs muab kev saib xyuas CKD suav nrog lub sijhawm tsis txaus rau kev tswj cov txheej txheem kab mob nyuaj, kev them nyiaj rov qab tsis pub dhau, cov qauv EMR nruj, thiab cov chaw kho mob thiab kev kawm tsis txaus. Kev txhawb nqa kev txiav txim siab hauv computer tau siv ntau ntxiv hauv cov ntaub ntawv kho mob hauv hluav taws xob los pab txhawb kev xa cov lus qhia-kev saib xyuas zoo thiab tej zaum yuav muaj txiaj ntsig tshwj xeeb ntawm PCPs uas feem ntau raug them rau kev tswj hwm cov neeg mob ntau yam thiab / lossis kev kho mob nyuaj thaum lub sij hawm sib ntsib luv luv. [47] Cov ntaub ntawv, txawm li cas los xij, qhia cov txiaj ntsig sib xyaw rau hnub tim ntawm qhov cuam tshuam ntawm EMR thiab cov cuab yeej kho mob hauv CKD kev tswj hwm. Kev taw qhia, piv txwv li, ntawm kev qhia eGFR automated tau cuam tshuam nrog nce kev txheeb xyuas ntawm CKD, tab sis tsuas yog kev txhim kho me ntsis hauv kev saib xyuas raws li ntsuas los ntawm feem pua ntawm cov xa mus lig rauNephrologylos yog cov tshuaj renin-angiotensin-aldosterone system antagonists.[48–50] Ib yam li ntawd, cov txheej txheem kev txiav txim siab kho mob tau ua rau tsuas yog kev txhim kho me me ntawm tus kws kho mob ua raws li CKD cov lus qhia. kom nkag siab tias yuav ua li cas zoo tshaj los siv cov cuab yeej txhawb nqa hluav taws xob kom muaj txiaj ntsig cuam tshuam rau kev saib xyuas tus neeg mob thiab cov txiaj ntsig.

Ntxiv rau cov lus qhia meej thiab meej thiab kev txhawb nqa kev txiav txim siab, PCPs xav tau kev siv zog ntau dua ntawm cov tsev kho mob hauv cov neeg mob, thiab/lossis yooj yim dua rau kev nkag mus rau ntau pawg neeg saib xyuas uas suav nrog cov kws noj zaub mov thiab kws muag tshuaj. Tam sim no, PCPs qhia txog qhov tsis muaj peev txheej thiab kev tsim kho vaj tse los txhawb kev saib xyuas CKD zoo. Cov qauv kev saib xyuas tus nqi xws li cov koom haum saib xyuas kev lav phib xaub (ACOs) thiab Cov Tsev Kho Mob-Centered Medical Homes muaj peev xwm hloov pauv kev saib xyuas thiab muab PCPs nrog cov peev txheej ntxiv los muab kev saib xyuas CKD zoo, tshwj xeeb tshaj yog rau cov neeg mob uas muaj ntau yam sib txawv. Muab qhov nyuaj ntawm CKD, kev sib koom tes ntxiv ntawm PCPs thiab lwm tus neeg muab kev pabcuam kuj tseem tuaj yeem pab txhawb kev pabcuam CKD kom muaj txiaj ntsig thiab muaj txiaj ntsig. Txog rau qhov kawg no, qhov kev sim tsis ntev los no tau qhia txog kev txhim kho me me hauv kev tswj hwm tshuaj hauv cov neeg mob CKD thaum cov kws muag tshuaj hauv zej zog tau txais kev cob qhia tsom rau hauv CKD.[55] Kev siv dav dav ntawm cov kev pab cuam uas pab txhawb nqa kev saib xyuas CKD zoo, txawm li cas los xij, tseem nyuaj rau lub sijhawm thiab kev kub ntxhov nyiaj txiag. Cov txiaj ntsig tau los ntawm kev sim siv thev naus laus zis xws li Kev Tshawb Fawb Txog Kev Tshawb Fawb Txog Kev Tshawb Fawb thiab Kev Kawm (KARE), kev tshawb fawb soj ntsuam kev ua tau zoo ntawm CKD daim ntawv teev npe hluav taws xob thiab kev tswj hwm tus kheej uas muaj cov xov tooj siv hluav taws xob thiab kev cob qhia kev noj qab haus huv, tuaj yeem qhia txog qhov muaj peev xwm. kev daws teeb meem rau qhov chaw kho mob thawj zaug.[56] Yog li ntawd, cov kev cuam tshuam uas muab cov neeg mob kev kawm thiab kev txhawb nqa kev tswj tus kheej nrog cov peev txheej uas pab txhawb kev tswj hwm CKD zoo tshaj plaws hauv kev saib xyuas thawj zaug yuav yog qhov tseem ceeb rau kev daws ntau yam teeb meem uas tau hais los ntawm PCPs. Thaum kawg, kev siv zog los txhawb kev paub txog CKD hauv kev paub txog kev sib raug zoo-raws li tau ua tiav nrog cov kab mob plawv thiab mob qog noj ntshav, piv txwv li-yuav pab tau cov kws kho mob thiab cov neeg mob pom cov hom phiaj sib koom. Muab cov kev cov nyom, nws yuav tsim nyog rau PCPs coj cov kev pab cuam rau cov neeg mob uas muaj kev pheej hmoo siab tshaj plaws rau CKD kev loj hlob lossis muaj feem cuam tshuam xws li kab mob plawv. txawm hais tias kev siv tseem qis dua.[41, 62]

Cov kev txwv ntawm qhov kev tshawb fawb no tsim nyog hais. Tus qauv loj me me thiab qhov kev xav ntawm cov kws kho mob hauv qhov kev tshawb fawb no yuav tsis sawv cev rau txhua qhov kev sib tw ua haujlwm thoob plaws ntau haiv neeg ntawm cov kws kho mob (xws li cov kws kho mob thiab cov kws kho mob) lossis cov chaw xyaum ua haujlwm. Txawm li cas los xij, peb txoj kev tshawb fawb suav nrog cov neeg tuaj koom sawv cev rau ntau haiv neeg thiab cov yam ntxwv ntawm kev coj ua. Qhov thib ob, peb txoj kev tshawb fawb tsom rau cov kws kho mob thawj zaug. Cov pab pawg tsom mus rau cov neeg mob kuj tseem tuaj yeem muab kev nkag siab ntxiv txog kev cuam tshuam rau kev saib xyuas cov neeg mob nrog CKD hauv qhov chaw saib xyuas thawj zaug.

Hauv kev xaus, PCPs tau txheeb xyuas ntau tus neeg mob hloov tau-, cov neeg muab kev pabcuam-, thiab cov txheej txheem-theem teeb meem rau kev saib xyuas zoo ntawm cov neeg mob CKD. Cov kws kho mob no kuj tau txheeb xyuas cov neeg muaj peev xwm los muab kev saib xyuas CKD zoo dua hauv qhov chaw saib xyuas thawj zaug. Txhawm rau txhim kho kev saib xyuas thiab kho cov txiaj ntsig ntawm cov neeg mob nrog CKD thiab ua tiav Cov Neeg Noj Qab Haus Huv 2020 CKD cov hom phiaj, yuav tsum tau siv zog los txhim kho kev tshaj tawm cov cuab yeej thiab cov peev txheej uas tuaj yeem siv tau hauv kev saib xyuas thawj coj los pab txhawb kev txhim kho cov neeg mob kev paub txog CKD.[63] Kev txhim kho cov neeg mob nkag mus rau kev tswj hwm tus kheej los pab txo lawv cov kev pheej hmoo CKD kuj tseem xav tau. Tsis tas li ntawd, kev cuam tshuam thiab kev hloov kho kev noj qab haus huv uas txhim kho PCPs 'CKD kev paub, pab txhawb PCPs cov lus qhia-kev sib koom ua ke, thiab / lossis kev sib koom ua ke ntau pab pawg yuav txhim kho PCPs lub peev xwm los saib xyuas cov neeg mob CKD zoo.

Improve Kidney disease--Cistanche acteoside

Sau Kev Pab Txhawb

Conceptualization:

Khaled Abdel-Kader, Clarissa J. Diamantidis, Michelle M. Estrella, Kerri Cavanaugh, Michael J. Choi, Bernard G. Jaar, Raquel C. Greer.

Kev kho cov ntaub ntawv:

Raquel C. Greer.

Kev txheeb xyuas raug cai:

C. John Sperati, Varun Agrawal, Yang Liu, Khaled Abdel-Kader, Clarissa J. Diamantidis, Michelle M. Estrella, Kerri Cavanaugh, Laura Plantinga, Jane Schell, James Simon, Joseph A. Vassalotti, Michael J. Choi, Bernard G . Jaar, Raquel C. Greer.

Kev tshawb nrhiav:

Raquel C. Greer.

Txoj kev:

Raquel C. Greer.

Kev saib xyuas:

Raquel C. Greer.

Sau - original draft:

C. John Sperati, Sandeep Soman, Raquel C. Greer.

Sau - tshuaj xyuas & kho:

C. John Sperati, Sandeep Soman, Varun Agrawal, Yang Liu, Khaled Abdel-Kader, Clarissa J. Diamantidis, Michelle M. Estrella, Kerri Cavanaugh, Laura Plantinga, Jane Schell, James Simon, Joseph A. Vassalotti, Michael J. Choi , Bernard G. Jaar, Raquel C. Greer.

Cov ntaub ntawv

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Cov kab mob raum ntev ua rau cov kab mob cerebral microbleeds hauv nas thiab txiv neej

Kev kho mob raum theem kawg: hloov raum rau hauv cov neeg mob Primary hyperoxaluria