Supplementary Material for: Chronic Kidney Disease in Brazil: Current Status and Recommended Improvements

Background: Over the last three decades, over 700 million individuals worldwide have been diagnosed with chronic kidney disease (CKD). In a 2017 survey in southern Brazil, 11.4% of those surveyed had CKD. Early identification and effective therapy in Brazil may reduce chronic kidney disease's impact. This panel discusses the early diagnosis and treatment of CKD and the barriers and actions needed to improve the management of CKD in Brazil. A panel of Brazilian nephrologists was provided with relevant questions to address before a multi-day conference. During this meeting, each narrative was discussed and edited through several rounds until agreement on the relevant topics and recommendations was achieved.
Summary: Panelists highlighted hurdles to early diagnosis and treatment of CKD. These include, but are not limited to, a lack of public and patient education, updated recommendations, multi-disciplinary CKD treatment, and a national CKD database.
Key Messages: People-centered, physician-centered, and healthcare institution-centered actions can be taken to improve outcomes. Patient empowerment is needed via multiple channels of CKD education and access to health-monitoring wearables and apps. Primary care clinicians and non-specialists must be trained to screen and manage CKD-causing illnesses, including diabetes and hypertension. The healthcare system may implement a national health data gathering system, more screening tests, automated test result reporting, and telehealth. Increasing access to early diagnosis can provide a path to improving care for patients with CKD. Concerted efforts from all stakeholders are needed to overcome the barriers.

背景：近三十年来，全球已有超过7亿人被确诊为慢性肾脏病（chronic kidney disease, CKD）。2017年巴西南部的一项调查显示，受访人群中11.4%患有CKD。在巴西开展早期识别与有效治疗，或可减轻慢性肾脏病带来的疾病负担。本次专题小组研讨围绕巴西慢性肾脏病的早期诊疗、改善疾病管理所需的障碍与应对举措展开。会前，巴西肾脏病学专家小组已明确需研讨的相关议题；会议期间，各方对各项论述内容进行多轮研讨与修订，直至就核心议题与推荐方案达成共识。总结：专题小组指出了慢性肾脏病早期诊疗面临的诸多障碍，其中包括但不限于：公众与患者健康教育匮乏、更新版诊疗指南缺失、多学科CKD诊疗体系不完善，以及全国性CKD数据库缺位。核心观点：可通过以患者为中心、以医师为中心、以医疗机构为中心的多维度举措优化诊疗结局。需通过多渠道开展CKD健康教育，推广健康监测可穿戴设备与移动应用程序，以提升患者的疾病自主管理能力。基层医疗临床医师与非专科医师需接受针对性培训，掌握慢性肾脏病相关致病疾病（如糖尿病与高血压）的筛查与管理方法。医疗系统可搭建全国性健康数据采集系统，增加筛查项目覆盖，实现检验结果自动化上报，并推广远程医疗服务。提升早期诊断覆盖率可为改善慢性肾脏病患者的诊疗质量提供可行路径。需动员所有利益相关方协同发力，方能攻克上述诊疗障碍。