Start By Implementing The Best Medication To Achieve Fair And Appropriate Kidney Disease Treatment!
Mar 14, 2024
Given the current rising incidence of chronic kidney disease worldwide and the general lack of public knowledge about the prevention and treatment of the disease, the International Society of Nephrology and the International Alliance of Kidney Funds jointly proposed that the second Thursday of March every year be determined from 2006. World Kidney Day aims to raise awareness of chronic kidney disease and related cardiovascular disease and mortality and to highlight the urgent global need for early detection and prevention of chronic kidney disease. March 14, 2024, is the 19th World Kidney Day. This time's theme is "Promoting medical equality and optimizing medication practices."
On this special day, the Yimaitong Kidney Channel was honored to invite Academician Liu Zhihong, director of the Eastern Theater Command General Hospital and the National Kidney Disease Clinical Research Center, and conducted a relevant interview with her based on this year's theme. I hope this interview can help more people understand the current status of kidney disease diagnosis and treatment, as well as the direction in which doctors, patients, and even society as a whole can work together.
Question 1:
The theme of this year's World Kidney Day is "Promoting Medical Equality and Optimizing Medication Practices." In daily clinical practice, due to various reasons, not all patients with kidney disease can receive the best drug management. In your daily work, what are the reasons that may cause patients with kidney disease to not receive the best treatment?
Academician Liu Zhihong: The International Society of Nephrology has set the theme of this year's World Kidney Day as "Kidney Health for All – Promoting Equitable Access to Medical Care and Implementation of Best Medications", which shows that equitable access to medical care and implementation of best medications have been achieved in the field of kidney disease. It is a prominent issue globally. What are the specific reasons that may cause kidney disease patients to not receive the best treatment? First of all, we need to understand the current diagnosis and treatment status of patients with chronic kidney disease (CKD). Generally speaking, its characteristics can be summarized as "three highs and one low": high risk The morbidity rate, high disability rate, high medical costs, and low awareness rate have become important public health issues that endanger human health on a global scale. In terms of prevalence, it is estimated that the number of CKD patients worldwide is about 850 million, and the number of patients in my country is nearly 110 million. According to the Global Burden of Disease Study, more than 3.1 million people died from kidney failure in 2019, making it the seventh leading risk factor for death globally. Although a large proportion of CKD can be prevented through healthy lifestyles, prevention and control of risk factors, avoidance of acute kidney injury, optimization of maternal and child health, and rational drug treatment, not all patients with kidney disease can receive optimal treatment in daily clinical practice. The main reasons for drug management are as follows:
Low early diagnosis rates and low awareness rates are the biggest obstacles preventing CKD patients from obtaining appropriate treatment. Judging from the research results, CKD patients have a very low awareness rate of the diagnosis of their disease. 80% to 95% of patients worldwide do not know their diagnosis results. This causes many patients to lose the best opportunity for treatment, which inevitably leads to Progression to end-stage renal insufficiency (ESRD).
Differences in doctors' acceptance of new treatments with clear evidence have resulted in low clinical use of the best treatments recommended by guidelines. Historical experience shows that it takes an average of 17 years to move a new treatment from clinical evidence to daily practice. For example, renin-angiotensin-aldosterone system inhibitors (ACEIs or ARBs), although these drugs have been known for decades to have important protective effects on kidney and heart function in CKD patients, according to real data from electronic health records, Their usage remains low, with U.S. statistics indicating only 20-40% usage. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are an important development in the field of CKD in recent years. Adding SGLT2 inhibitors to the standard treatment of CKD patients can reduce the risks of eGFR decline, heart failure, and cardiovascular death by approximately 40%. However, the clinical use of SGLT2 inhibitors is obviously insufficient. In the CURE-CKD cohort, only 5% of CKD patients used SGLT2 inhibitors for more than 90 days. In addition to SGLT2 inhibitors, in type 2 diabetes, nonsteroidal mineralocorticoid receptor antagonists (fennelidone) have been shown to further reduce CKD progression, kidney function, and other standard treatments such as RAS inhibitors. Risk of failure, cardiovascular events, and death. Subgroup analysis data of Chinese patients in the FIDELIO-DKD study showed that the relative risk of renal composite endpoint events in the fenceline treatment group was significantly reduced by 41% compared with the placebo control group, and the risk of cardiovascular composite endpoint events was reduced by 25%. The Chinese type 2 diabetes-related CKD population has shown excellent dual kidney and heart benefits. This study provides new key evidence for delaying the progression of CKD and improving patient prognosis. It also urgently needs to be promoted in clinical practice.
Factors associated with patient compliance. The treatment of CKD is a long-term comprehensive treatment process, and patient compliance is also an important factor in determining treatment outcomes. The main reasons for poor compliance are rejection of adverse drug reactions, uncertainty about drug efficacy, insufficient attention to the disease, too many types and times of taking drugs, forgetfulness by patients or caregivers, as well as high cost of treatment and the relationship between patients and patients. Insufficient communication from doctors, etc.
The influence of factors such as medical and health policies and medical insurance. Since the launch of the World Health Organization's Noncommunicable Diseases Action Plan in 2013, the proportion of countries around the world with national noncommunicable disease plans and dedicated noncommunicable disease units has increased year by year, but CKD is only included in noncommunicable diseases in about half of the countries. disease strategies. The high cost of CKD treatment is also an important obstacle that restricts patients from obtaining the best treatment. As CKD progresses, treatment costs increase exponentially, not only because of the cost of dialysis and transplantation but also because of the multiple comorbidities and complications that accumulate over time. In 2021, the cost of medical insurance services for all CKD patients in the United States will be US$86.1 billion (accounting for 22.6% of total expenditure). Medical insurance coverage and reimbursement rates are crucial for CKD patients.
To improve the long-term prognosis of CKD patients, promoting medical equality and optimizing medication practices are indispensable. We should take World Kidney Disease Day as an opportunity to call on policymakers, medical staff, patients and the general population to work together to pay attention to the management of CKD and kidney health maintenance, strengthen relevant policy formulation, science popularization and knowledge promotion, and promote drug accessibility and Improve patient compliance, promote the prevention and treatment of kidney disease in our country to a higher level, and contribute to "Healthy China".
Question 2:
Access to equitable and appropriate medical care is also a huge issue for patients with end-stage renal disease. In particular, how to fairly choose a suitable renal replacement therapy method has always been an aspect worthy of discussion. How do you recommend appropriate renal replacement therapy for patients with end-stage renal disease? Such as hemodialysis, peritoneal dialysis, and kidney transplantation.
Renal replacement therapy is an effective method for the treatment of patients with end-stage renal disease. It can save and maintain the lives of uremia patients and improve their quality of life. According to their different mechanisms of action, there are three main methods of renal replacement therapy: hemodialysis, peritoneal dialysis, and kidney transplantation. Each method has its advantages and disadvantages and needs to be selected according to the specific situation of the patient.
Hemodialysis is the most commonly used renal replacement therapy. It mainly uses the principle of osmosis and diffusion of liquid to remove toxins and excess water produced in the body. The advantage is that it can quickly remove accumulated toxicity in the body, stabilize the internal environment, and can also accurately control Capacity, because the dialysis process is performed in the hospital and is performed by professional medical staff, the quality of the dialysis process is guaranteed and the patient's survival period is significantly extended. The blood purification center where the author works has patients who have been undergoing dialysis for more than 40 years. However, the shortcomings of hemodialysis are also obvious. Once a patient starts dialysis, he must go to the hospital for treatment regularly and cannot be interrupted at will, which will have a certain impact on the patient's normal life and work. Secondly, hemodialysis patients must establish appropriate vascular access, and some Patients with poor vascular conditions will cause some trouble; in addition, long-term hemodialysis patients will suffer from various complications such as renal anemia, renal bone disease, malnutrition, heart failure, valve calcification and other complications.
Peritoneal dialysis is also a common treatment modality for patients with end-stage renal disease. The principle is to use the peritoneum as a semipermeable membrane to exchange solutes and water through changes in osmotic pressure, thereby replacing excess water and toxins in the body into the abdominal cavity. Peritoneal dialysis has the advantages of no need for special equipment, little impact on hemodynamics, little impact on residual renal function, no need for anticoagulation, and little impact on daily life (the patient and his family can perform the operation by themselves). Peritoneal dialysis can be given priority to patients with end-stage renal disease, such as infants and children, whose cardiovascular status is unstable, obvious bleeding or bleeding tendency, poor vascular conditions or repeated arteriovenous fistula failure, good residual renal function, and hemodialysis treatment is inconvenient to wait. However, the shortcomings of peritoneal dialysis also limit its long-term clinical application. Because peritoneal dialysis uses the body's own omentum, it increases the risk of peritonitis infection. At the same time, the clearance of small molecules is not as good as hemodialysis, and protein loss is greater than that of hemodialysis. The patient himself Malnutrition may occur. In addition, patients with extensive peritoneal adhesions, abdominal wall lesions that affect catheterization, or severe peritoneal defects should not choose peritoneal dialysis.
Kidney transplantation is a method of surgically implanting a kidney from a donor into a recipient to restore kidney function. It is the kidney replacement treatment method closest to the physiological state. A successful kidney transplant can fully restore kidney function. Compared with dialysis patients With the best quality of life, the lowest cost of maintenance treatment, and the highest survival rate, it has become the preferred treatment method for patients with end-stage renal disease. However, due to limitations in donor sources, kidney transplantation cannot be widely used in clinical practice. After kidney transplantation, patients need to take lifelong immunosuppressive drugs to prevent rejection, which will cause side effects of the drugs and increase the risk of infection and tumors. In addition, kidney transplantation patients also have surgical complications and primary diseases in the transplanted kidney. Problems such as recurrence, acute and chronic rejection, and infection have a certain impact on the long-term survival of the patient's transplanted kidney.
In summary, among the three methods of renal replacement therapy, various factors such as patient age, primary disease, severity of illness, residual renal function, family factors, economic conditions, patient wishes, etc. need to be comprehensively considered to select the most suitable method for the patient, and The three methods can also be switched according to the patient's condition to ensure that the patient receives the best medical care.
Question 3:
Compared with previous years, this year's World Kidney Day logo has undergone significant changes, adding green to the original red, yellow, and blue colors. In addition to expressing concern about environmental issues, green also means that the whole society should pay attention to kidney disease. What do you think healthcare professionals and patient organizations can do to increase awareness and self-management of kidney disease among patients and the general public?
Green nephrology is a new concept that has emerged in the field of kidney disease in recent years. It aims to study the two-way relationship between the environment and kidney disease. On the one hand, environmental changes will have an increasing impact on the pattern of kidney disease. , on the other hand, the treatment of kidney disease (especially dialysis treatment) is also an important cause of large carbon emissions and resource consumption. There is clear evidence that environmental change, particularly climate change, has and will increasingly have an impact on the incidence and distribution of kidney disease and that increases in extreme weather events due to climate change may have destabilizing effects on the care of patients with kidney disease; On the contrary, the resource consumption and greenhouse gas emissions caused by medical activities have also received more attention, especially the impact of dialysis on the environment. The nephrology community should play an important role in exploring environmentally friendly medical practices by utilizing renewable energy and improving waste management. The concept of green kidney disease is implemented through management, reducing dialysate flow rate, and strengthening monitoring of resource use and waste generation. The addition of green elements to the logo of this year's World Kidney Day is also an initiative to further promote the concept of green kidney disease and call on everyone to pay attention to the environment and kidney disease.
In the management of chronic diseases such as CKD, patients' self-management ability occupies an increasingly important position. To improve patients' and the public's awareness and self-management ability of kidney disease, medical professionals, patients, society and communities need to work together. Medical professionals need to make full use of their own professional knowledge advantages to strengthen science popularization and patient education, use self-media, the Internet, newspapers and magazines, and other platforms to publish relevant science knowledge, and increase the proportion of self-screening among patients, especially for those with diabetes, People with high blood pressure, family history of kidney disease, cardiovascular disease, hyperuricemia, advanced age (>65 years old), obesity, long-term use of drugs that may cause kidney damage, and a history of acute kidney injury should undergo regular physical examinations and screenings. This can improve the early diagnosis rate of CKD and significantly delay the progression of CKD patients to end-stage renal disease. Secondly, medical professionals also need to convey information about the dangers and effective preventive measures of CKD to health policy decision-making departments to provide a basis for formulating more reasonable health policies. For patients and patient organizations, it is most critical to improve their ability to manage the disease. Compliance with drug treatment and changes in daily lifestyle requires the joint efforts of patients and families, regular work and rest, avoiding fatigue, avoiding emotional stress, quitting smoking and drinking, reasonable diet and other healthy lifestyles are not easy for patients to implement in their daily lives. It requires the joint participation of patients' family members and professionals to achieve better results. Capacity building for patient self-management is divided into many aspects, such as disease recognition, emotional control, self-care, medication management, physical exercise, partnership, etc. Patients and related organizations can start from small aspects and continuously enhance their self-management capabilities. Management ability, through various intervention measures such as drugs, lifestyle, and psychological construction, to achieve the purpose of improving disease prognosis and improving quality of life.
How Does Cistanche Treat Kidney Disease?
Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.
Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.
Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.
Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.
Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.
Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.
Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.
In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.
In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.
