关键字：KDOQ,I慢性肾脏病,骨代谢,Bone Metabolism and Disease,CKD
简介：FROM ITS rudimentary beginnings in the 1960s, through its widespread and increasing availability to the present, dialysis has provided lifesaving replacement therapy for millions of individuals with end-stage renal disease (ESRD). Parallel advances in understanding the course of progressive kidney disease and its complications have resulted in the development of interventions that can slow the progression and ameliorate the complications of chronic kidney disease (CKD). Thus, while dialysis has made it possible to prolong the lives of patients with ESRD, today it is also possible to retard the course of progression of kidney disease, to treat accompanying comorbidities earlier, and to improve the outcomes and quality of life of all individuals afflicted with kidney disease, well before replacement therapy becomes necessary.
Yet, the application of these advances remains inconsistent, resulting in variations in clinical practice and, sadly, in avoidable differences in
In keeping with its longstanding commitment to improving the quality of care delivered to all patients with kidney disease and the firm conviction that substantial improvements in the quality and outcomes of their care are achievable, the National Kidney Foundation (NKF) launched in 1995 the Dialysis Outcomes Quality Initiative (DOQI), supported by an educational grant from Amgen, Inc., to develop clinical practice guidelines for dialysis. Since their publication in 1997, the DOQI Guidelines have had a significant and measurable impact on the care and outcomes of dialysis patients.1,2 The frequency with which they continue to be cited in the literature and serve as the focus of national and international symposia is but a partial measure of their impact. The DOQI Guidelines have also been translated into more than a dozen languages; selected components of the Guidelines have been adopted in various countries across the world; and they have provided the basis of clinical performance measures developed and put into effect by the Health Care Financing Administration (now renamed the Center for Medicare and Medicaid Services [CMS] in the United States).
In the course of development of DOQI it became evident that, in order to further improve dialysis outcomes, it was necessary to improve the health status of those who reach ESRD, and that therein existed an even greater opportunity to improve outcomes for all individuals with kidney disease, from earliest kidney injury
through the various stages of progression to kidney failure, when replacement therapy becomes necessary. It was on this basis that in the
fall of 1999, the Board of Directors of the NKF approved a proposal to move the clinical practice guideline initiative into a new phase, in which its scope would be enlarged to encompass the entire spectrum of kidney disease. This enlarged scope increases the potential impact of improving outcomes of care from the hundreds of thousands on dialysis to the millions of individuals with kidney disease who may never require dialysis. To reflect these expanded goals, the reference to “dialysis” in DOQI was changed to “disease,” and the new initiative was termed the Kidney Disease Outcomes Quality Initiative (K/DOQI).