Established therapeutic interventions effectively mitigate the risk and progression of chronic kidney disease (CKD). Countries and regions have a compelling need for organizational structures that enable early identification of people with CKD who can benefit from these proven interventions. We report the current global status of CKD detection programs. A multinational cross-sectional survey. Stakeholders, including nephrologist leaders, policymakers, and patient advocates from 167 countries, participating in the International Society of Nephrology (ISN) survey from June to September 2022. Structures for the detection and monitoring of CKD, including CKD surveillance systems in the form of registries, community-based detection programs, case-finding practices, and availability of measurement tools for risk identification. Descriptive statistics. Of all participating countries, 19% (n=31) reported CKD registries, and 25% (n=40) reported implementing CKD detection programs as part of their national policies. There were variations in CKD detection program, with 50% (n=20) using a reactive approach (managing cases as identified) and 50% (n=20) actively pursuing case-finding in at-risk populations. Routine case-finding for CKD in high-risk populations was widespread, particularly for diabetes (n=152; 91%) and hypertension (n=148; 89%). Access to diagnostic tools, estimated glomerular filtration rate (eGFR), and urine albumin-creatinine ratio (UACR) was limited, especially in low-income (LICs) and lower-middle-income (LMICs) countries, at primary (eGFR: LICs 22%, LMICs 39%, UACR: LICs 28%, LMICs 39%) and secondary/tertiary health care levels (eGFR: LICs 39%, LMICs 73%, UACR: LICs 44%, LMICs 70%), potentially hindering CKD detection. A lack of detailed data prevented an in-depth analysis. This comprehensive survey highlights a global heterogeneity in the organization and structures (surveillance systems and detection programs and tools) for early identification of CKD. Ongoing efforts should be geared toward bridging such disparities to optimally prevent the onset and progression of CKD and its complications. Early detection and management of chronic kidney disease (CKD) is crucial to prevent progression to kidney failure. A multinational survey across 167 countries revealed disparities in CKD detection programs. Only 19% reported CKD registries, and 25% implemented detection programs as part of their national policy. Half used a reactive approach while others actively pursued case-finding in at-risk populations. Routine case-finding was common for individuals with diabetes and hypertension. However, limited access to gold standard tools such as estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR), especially in low-income and lower-middle income countries, may hinder CKD detection. A global effort to bridge these disparities is needed to optimally prevent the onset and progression of CKD and its complications.

中文翻译：

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世界国家和地区 CKD 检测和监测的组织和结构：来自全球调查的观测数据


既定的治疗干预措施可有效减轻慢性肾脏病（CKD）的风险和进展。各个国家和地区迫切需要建立能够及早识别 CKD 患者的组织结构，这些患者可以从这些行之有效的干预措施中受益。我们报告 CKD 检测项目的当前全球状况。一项跨国横断面调查。利益相关者，包括来自 167 个国家的肾病专家领导、政策制定者和患者权益倡导者，参与 2022 年 6 月至 9 月的国际肾病学会 (ISN) 调查。 CKD 检测和监测结构，包括登记形式的 CKD 监测系统、基于社区的检测计划、病例发现实践以及风险识别测量工具的可用性。描述性统计。在所有参与国家中，19% (n=31) 报告了 CKD 登记情况，25% (n=40) 报告将实施 CKD 检测计划作为其国家政策的一部分。 CKD 检测计划存在差异，50% (n=20) 使用反应性方法（管理已识别的病例），50% (n=20) 积极在高危人群中进行病例发现。高危人群中 CKD 的常规病例发现十分普遍，尤其是糖尿病（n=152；91%）和高血压（n=148；89%）。获得诊断工具、估计肾小球滤过率 (eGFR) 和尿白蛋白肌酐比 (UACR) 的机会有限，尤其是在低收入 (LIC) 和中低收入 (LMIC) 国家（eGFR：LIC） 22%，中低收入国家 39%，UACR：中低收入国家 28%，中低收入国家 39%）和二级/三级医疗保健水平（eGFR：中低收入国家 39%，中低收入国家 73%，UACR：中低收入国家 44%，中低收入国家 70%），可能阻碍 CKD 检测。 由于缺乏详细数据，无法进行深入分析。这项综合调查强调了早期识别 CKD 的组织和结构（监测系统和检测程序和工具）的全球异质性。持续的努力应该致力于弥合这种差异，以最佳地预防 CKD 及其并发症的发生和进展。早期发现和治疗慢性肾脏病（CKD）对于防止进展为肾衰竭至关重要。一项针对 167 个国家/地区的跨国调查揭示了 CKD 检测计划的差异。只有 19% 的国家报告了 CKD 登记情况，25% 的国家将检测计划作为其国家政策的一部分实施。一半的人采取被动的方法，而其他人则积极地在高危人群中寻找病例。对于糖尿病和高血压患者来说，常规病例发现很常见。然而，估计肾小球滤过率 (eGFR) 和尿白蛋白肌酐比 (UACR) 等黄金标准工具的获取机会有限，尤其是在低收入和中低收入国家，可能会阻碍 CKD 检测。需要全球努力弥合这些差异，以最佳地预防 CKD 及其并发症的发生和进展。