More than 2,000 years ago, the Yellow Emperor’s Classic of Internal Medicine proposed that “the top doctor treats the untreated disease, the middle doctor treats the desired disease, and the bottom doctor treats the existing disease”, which means that the most skilled doctor is not the one who is good at treating diseases, but the one who can prevent them. The “cure for the untreated” is aimed at the majority of healthy or self-proclaimed “healthy” people, while chronic kidney disease has the special characteristics of insidious onset, high incidence and long course, without the participation of authoritative medical institutions and the public’s positive response, the “upper medical treatment for the untreated” is not the best. If there is no participation of authoritative medical institutions and positive response from the public, the “treatment of chronic kidney disease” will become a paper exercise. The latest data from the World Health Organization shows that the prevalence of chronic kidney disease is about 7% to 10% in people over 40 years old, which is no less than the incidence of diabetes and hypertension and has become one of the major diseases threatening the world. More than 1 million people around the world are on dialysis and the number is growing at an average rate of 8% per year, and the incidence of chronic kidney disease is also showing a younger trend, with more and more dialysis patients in their twenties and thirties and the youngest even less than 10 years old. In China, the total number of dialysis patients exceeded 100,000 in 2011, and represents only 10% of the total number of patients requiring dialysis. The current annual cost of dialysis treatment exceeds $9.6 billion, and if all uremic patients could receive dialysis treatment, it would cost more than 50% of the country’s total health expenditure. Such an alarmingly large amount of money will be a potential threat to the successful implementation of the national public hospital reform, but in fact, the general public has very little knowledge about the prevention and treatment of chronic kidney disease. Chronic kidney disease is characterized by the “three highs” of high prevalence, high rate of combined cardiovascular disease and high mortality, as well as the “three lows” of low awareness, low prevention and treatment, and low awareness of combined cardiovascular disease. Because of the insidious onset of chronic kidney disease, most patients have almost no symptoms in the early stage; even if there are symptoms, they may not be specific to kidney disease, so they are easily overlooked by patients and delayed in treatment. In contrast, the incidence of early chronic kidney disease is 100 times higher than that of renal failure. If early and effective intervention and treatment are carried out to control risk factors, the progression of kidney disease can be delayed and even the incidence of renal failure can be reduced. Therefore, doctors should effectively increase the awareness of kidney disease through various ways and means. In clinical work, the role of health care professionals is not only to prescribe medication to patients, but more importantly, to teach patients appropriate knowledge and some skills to change their lifestyles, so that patients can actively participate in all decisions of treatment self-management. To fundamentally reverse the situation of “three highs” and “three lows” in the prevention and treatment of chronic kidney disease, the whole society needs to be proactive in the prevention and treatment of chronic kidney disease, just like the prevention and treatment of cardiovascular disease, tumors and diabetes. The whole society needs to educate and educate the chronic kidney disease patients. Early prevention and treatment should be strengthened to prevent the occurrence of chronic kidney disease. Strengthen the tertiary prevention of chronic kidney disease. The so-called primary prevention refers not only to the timely and effective treatment of existing kidney disorders (such as chronic nephritis) and extremely risk factors (such as hypertension and proteinuria), but also includes the timely and effective treatment or control of disorders (such as diabetes, hypertension, etc.) and risk factors (such as smoking, hyperlipidemia, etc.) that may cause kidney damage to prevent the occurrence and development of chronic kidney disease. Secondary prevention refers to the timely treatment of existing chronic kidney disease with regard to the risk factors for its progression to delay or reverse the progression of chronic kidney disease. Tertiary prevention refers to the prevention and treatment of serious complications of all systems in uremic patients, especially cardiovascular complications, with the aim of reducing the morbidity and mortality of uremia and improving its long-term survival rate. Second, popular science education and community physician primary care system can alleviate the increasingly prominent contradiction of difficult and expensive medical care Chronic kidney disease research has developed very rapidly in recent years, and many new theories and techniques are not even elaborated in any of the national higher education textbooks. Due to the economic level, regional openness, continuing education and capacity development of doctors, the level of diagnosis and treatment varies greatly from region to region, resulting in the phenomenon that tertiary hospitals are overcrowded while primary and secondary hospitals are deserted. In order not to miss the diagnosis, misdiagnosis or some economic interests driven, many doctors will consciously or unconsciously conduct a large number of repeated tests or upgrade the examination, which in effect increased the “expensive medical care”, but also easy to be accused of “excessive medical care”. The Minister of Health, Chen Zhu, recently analyzed the situation in the report on deepening the reform of the medical and health system, the main manifestation and characteristics of the “difficulty in seeing a doctor” in China is the “relative” difficulty in seeing a doctor, which refers to the shortage of quality medical resources relative to the needs of the residents, resulting in patients It is “difficult” to go to a large hospital to see a specialist. This is highlighted by the fact that many people flock to large hospitals for minor injuries and illnesses, and that large hospitals are overcrowded. Recently, we analyzed up to 140,000 kidney disease patient visits in 2012, and found that more than 50% were foreign patients, while more than 60% of patients could be seen and followed up in primary and secondary hospitals. The U.S. also has the problem of difficult and expensive medical care, but its family physician primary care system is enforced, and large general hospitals only accept patients by appointment, so that doctors at all levels and hospitals at all levels do their own jobs, and the distribution of medical resources is relatively balanced. If our community doctors are very good and trustworthy general practitioners, you can make a phone call or walk three or five steps to see a doctor in the lane, is it still difficult to see a doctor? If patients can have some knowledge of chronic kidney disease, on the one hand, by optimizing their lifestyle and diet, they can get less disease, and on the other hand, they can find the right community doctor, how expensive is it to see a doctor? Third, the object, form and content of medical knowledge popularization education should be diversified 1, the object of popularization education Although the popularization activities have received the support and response of many patients and families, few young people can actively participate. Advocated by the International Society of Nephrology and the International Kidney Foundation, World Kidney Day is positioned on the second Thursday of March every year. Since 2006, tens of thousands of people in Shanghai have participated in this large scale scientific and educational event every year. Our department has been actively participating in and organizing the World Kidney Day activities, but the age structure shows that the participants are mainly middle-aged and elderly, and some of them are even old faces who come to visit every year, while the age of onset of chronic kidney disease shows that young people should be the main participants of the popularization activities. We have made a questionnaire survey on 250 young patients under 40 years old who were found to have chronic kidney disease during physical examination, and found that 70% of the patients did not have any symptoms before diagnosis, and only 5% of them had participated in any form of popularization activities, and after careful analysis, 90% of the patients had improper lifestyle, diet or chronic kidney disease predisposing factors such as hypertension, diabetes, obesity and family history of kidney disease. This shows that the population of chronic kidney disease science education must not be limited to kidney disease patients, some “healthy” young people should consciously and regularly participate in health education, early detection, early treatment, in order to finally stay away from chronic kidney disease. Should clinical workers themselves be educated in science? The answer is yes. As a matter of fact, the boundary between the scientific content of medical knowledge and professional and technical knowledge is not absolutely clear, which is related to the composition of the educated population, the level of education, the proficiency of mastering relevant basic medical knowledge and the interest of attention. At present, the overall health condition of medical workers is worrying. Although it is related to the intensity and nature of their work, the indifference or overconfidence of medical workers towards their own health and “non-compliance with medical advice” are also important causes of health overdraft. The results of a survey published in the American Journal of Internal Medicine on April 11, 2011, show that when doctors change roles and become patients, they are the least likely to follow their treatment recommendations. The survey’s sponsor, Duke University scholar Peter Uebel, argued that the phenomenon is not a problem. Uebel interpreted this phenomenon, “It’s not about physician ethics, it’s about human nature.” He pointed out that when doctors become patients, they usually do not think about what kind of treatment they have suggested to their patients. Therefore, even if you are a medical professional, when you take off your white coat and become an ordinary patient, or when you encounter a “cold” problem that is not your specialty, or when you have missed a point of knowledge for a long time, it is still very important to receive popular education about medical knowledge. 2, the form of science popularization education The new chairman of the Chinese Association for Science and Technology, Han Qide, believes that the applicable and effective form of science popularization is a good form of science popularization, not necessarily the one-sided pursuit of novelty, high-tech form of science popularization, the author strongly agrees. At present, most forms of science popularization are based on radio, television or on-site lectures, supplemented by a variety of newspapers, magazines and reading materials, the way patients receive science popularization education is often passive, one-sided, fill-in-the-blank. Because each person needs to know different medical knowledge points, the dull and general form of popular science often gets half the result with twice the effort. Doctors and patients, patients and patients should be able to communicate and interact with each other at any time, especially for patients with serious and chronic diseases that require long-term treatment, they are more eager to receive immediate care and guidance from medical staff. According to a random survey of 450 uremic maintenance hemodialysis and peritoneal dialysis patients in our hospital, more than 80% of patients do not understand the basic principles and timing of hemodialysis or peritoneal dialysis, 75% of patients are unable to manage their diet correctly, and when they encounter sudden “minor problems” that do not require immediate hospital consultation (e.g., mild cold, torn package of peritoneal dialysis fluid, etc.), they are not able to understand how to manage their diet. When faced with a “minor problem” (e.g., a mild cold, a torn package of peritoneal dialysis solution, etc.) that does not require an immediate visit to the hospital, 60% of patients are overwhelmed or mismanaged. Although these problems are often repeatedly taught by the medical staff during inpatient and outpatient follow-up, they are ignored by the patients because they have not experienced them themselves. We believe that the establishment of a patient association is a good form of science education and disease prevention and control model. Through the patient association, the hospital side establishes a communication platform, allowing patients to communicate with each other in a family-like manner, with old patients driving new patients, experienced ones driving inexperienced ones, and issues of concern being raised for discussion. The medical staff plays the role of an organizer, speaker, instructor and commentator. In the interactive learning, patients often get more information than expected, and at the same time, it reduces the patient’s loneliness and helplessness, and enhances the relationship between doctors and patients. In order to keep the patient association from being a formality or having too long an “interval”, our department has established a 24-hour free service consultation hotline, so that patients can get satisfactory answers to any questions they may have anytime and anywhere. Since the establishment of the “Kidney Disease Home” patient association, more and more patients have improved their self-confidence in overcoming the disease and have also felt the improvement of their quality of life. Once they have UTI, many patients will go through a process from denial and resistance to helplessness and negativity to slow acceptance. Hemodialysis (including hemodialysis, peritoneal dialysis, and kidney transplantation) is the only effective way to treat uremia and prolong life, but the timing of its treatment should be sooner rather than later because complications such as cardiovascular events, malnutrition, and severe water-electrolyte acid-base imbalance will increase exponentially if treatment is too late. If a patient with uremia chooses hemodialysis, it is usually recommended to perform elective dialysis (make all relevant preparations before dialysis and start dialysis once the dialysis indications are met), while emergency dialysis is a situation when the patient has to undergo emergency dialysis due to severe uremia-related complications. At this time, the general condition of the patient is often very poor and the risk of dialysis is greatly increased. We analyzed a retrospective study of patients treated with hemodialysis in our hospital from January 2002 to December 2009 and found a total of 586 patients treated with hemodialysis, of whom 312 started with emergency hemodialysis and 274 started with elective hemodialysis, and the Kaplan-Meier survival curve suggested that the overall survival rate of elective hemodialysis was better than that of emergency hemodialysis (P < 0.05, log -rank test). In response to this situation, in addition to strengthening the popularization of kidney disease prevention and treatment, the department has also made it "mandatory" for all patients with chronic renal failure to join a patient's association, and with the patient's consent, attach the communication contact information of all patients, so that patients can communicate with each other at any time, help each other and truly become the master of overcoming the disease. We were surprised to find that in recent years, the overall trend of observing the proportion of emergency hemodialysis to the total number of hemodialysis patients has been decreasing year by year, and the long-term survival rate of uremic patients has improved significantly. 3, the content of popularization of science education The content of the popularization of knowledge on the prevention and treatment of chronic kidney disease should also keep pace with the times, and workers involved in popularization of science education should constantly update their knowledge, which is not limited to the content of a strong professional nature, such as the diet of chronic kidney disease, for a long time folk have been circulating kidney disease "soy products can not eat ", I do not know that although the protein in soybean products is a vegetable protein, but also a high-quality protein, compared to cereals and vegetables it contains more essential amino acids, in addition it can also provide calcium, vitamins and other beneficial substances. Therefore, kidney disease patients can choose the right amount according to their condition, do not need to see soy products as the enemy and absolutely prohibited. This seemingly very superficial scientific knowledge, I guess not everyone (including some doctors) are aware of it. Not long ago, the news that a patient in Dongguan, Guangdong Province died and owed "sky-high" medical bills caused a stir. Regardless of whether this incident is a medical malpractice, but the reporter to "January infusion 330 kg" as a headline is inappropriate, a little knowledge of kidney disease prevention and treatment are aware of the "continuous renal replacement therapy" (CRRT) therapy. It is a new blood purification technique that is somewhat similar to hemodialysis as we know it. CRRT must be equipped with a considerable amount of fluid, the journalist so thought to attract attention with this headline, but reveal their lack of basic medical knowledge, and greatly weaken the accuracy of the news. Therefore, with the rapidly changing knowledge of chronic kidney disease prevention and treatment, clinicians have an obligation to inform the general public of these new knowledge points in a concise manner through science education while doing their daily research work. With the joint efforts of doctors and patients, the prevention and treatment of chronic kidney disease will be more effective and the general public can finally stay away from kidney disease. At present, most clinicians are busy with heavy clinical and scientific research work, and the popularization of science is often not paid attention to, in a supporting role. In fact, there is no contradiction between the two. Professor Yang Binghui, a famous health educator, doctoral supervisor and former president of Zhongshan Hospital of Shanghai Medical University, has spared no effort in popularizing science education. He wears several hats, working as a doctor, health educator, teacher, radio DJ, and writing books. His calm, simple, humble tone and slightly dialectal Mandarin make him extraordinarily approachable and credible, and he always attracts countless admirers with each speech. Ordinary people are most in need of careful guidance from authoritative experts. If every famous medical expert can give equal importance to science education and clinical research work, and the national government can also give policy inclination in all aspects, the work of science education can flourish, the physical and mental health of the people can be guaranteed, and doctors can also reach the highest level of "treating the disease before the disease".