Management of patients with chronic kidney disease in the community

VernacularTitle:家庭医生制下依托分级诊疗开展慢性肾脏病健康管理的实践
Author: Zheng QI ¹ ; Shuai LIU ; Hongmei HUAN ; Xia CHEN ; Weimin YE ; Ping ZHANG ; Lan SUN ; Qi SHEN ; Weiying GU ; Xianya WEI
Author Information

1. 201107,上海市闵行区华漕社区卫生服务中心
Keywords: Disease management; Community health services; Chronic kidney disease
From: Chinese Journal of General Practitioners 2018;17(2):94-98
CountryChina
Language:Chinese
Abstract: Huacao Community Health Service Center has established an integrated chronic kidney disease (CKD) management system since 2015,which greatly improved CKD management in the community.From September 2016 to August 2017,4084 residents were screened by the family doctor team,975 were suspected to have CKD (23.87％),among whom 202 (20.72％) were referred to district CKD treatment center,and 197 (97.52％) were confirmed as CKD.The detection rate of suspected CKD among patients with hypertension and diabetes mellitus was the highest,which was much higher than that among outpatients and those with routine health check up.It is suggested that the integrated management of CKD should be widely implemented to cope with the prevalence of CKD,particularly for those with hypertension and diabetes.