In the long history of mankind, the evolution of the disease spectrum can be divided into three stages: “the era of plague and famine”, “the era of infectious diseases” and “the era of degenerative and man-made diseases”. The “era of plague and famine”, the “era of infectious diseases” and the “era of degenerative and man-made diseases”. Although there is still no shortage of plagues and famines in the world, and the prevalence of various infectious diseases, especially emerging infectious diseases, remains a serious challenge, it is important to face the fact that chronic non-infectious diseases have become a major health problem and cause of death for human beings [1]. Only from this macroscopic and global perspective can the importance of chronic kidney disease in the specialty of nephrology be understood strategically. After two decades of tireless efforts by cardiovascular specialists, the number of deaths from cardiovascular disease in the United States is now maintaining a stable to slightly decreasing trend; however, mortality from diabetes, hypertension, and kidney disease (nephritis, nephrotic syndrome, and nephrosclerosis) has increased unabated [2] From: Medical Education www.med66.com. The number of people on dialysis for chronic kidney failure worldwide increased from 426,000 in 1990 to 1,065,000 in 2000 and is expected to reach more than 2 million in 2010 [3]. This increase in the number of people has caused a rapid increase in the medical costs spent on dialysis: from 200 billion in the 1980s to about 450 billion in the 1990s, and is expected to reach more than a trillion in the first decade of the new century. This rapidly increasing cost has become a serious burden for even the developed industrialized countries. At the same time, developing and underdeveloped countries, which represent 80% of the global population, account for only 10% of the dialysis population, and most end-stage renal failure patients in these countries do not have access to dialysis for life-saving treatment. Therefore, the prevention and treatment of patients with chronic kidney disease in these countries is of special importance. On the other hand, although renal replacement therapy for chronic kidney failure has evolved considerably over the past half century, saving the lives of a large number of patients and becoming one of the brightest breakthroughs in the specialty of nephrology, a high percentage of patients still die from the comorbidities of dialysis, transplantation or the inherent problems of chronic kidney disease. According to statistics in the United States 21-23% of dialysis patients die each year [4]. A comparative study showed that the prognosis of patients with renal failure is similar to that of metastatic tumors. The leading cause of death in chronic renal failure as well as in dialysis patients is cardiovascular disease; in fact, many patients with chronic renal failure die from cardiovascular comorbidities before reaching dialysis. More than anything else, it is important to draw our attention to the fact that renal disease has been clearly identified as an independent risk factor for cardiovascular disease in the US Joint Report on Hypertension (JNC VII) [5]. Encouragingly, a large number of studies have demonstrated that early interventions in chronic kidney disease to treat hypertension, anemia, hyperlipidemia, calcium and phosphorus metabolism and bone disease can delay the impairment of renal function and reduce cardiovascular comorbidity and overall mortality in patients with chronic kidney disease [6]. For all these reasons, the common focus of international nephrology in recent years has shifted forward from the iceberg (chronic renal failure and its replacement therapy) to the huge pedestal hidden beneath it: chronic kidney disease (CKD). And the early diagnosis, monitoring and prevention of CKD has become a global public health event. R. Atkins, former president of the International Society of Nephrology (ISN), has also shifted from years of studying the pathogenesis of glomerular immunological damage to epidemiological studies of CKD. G. Eknoyan, N. Lameire, N. Levin, and other internationally recognized hemodialysis experts have also shifted their focus and interest to organizing the Kidney Disease: Improving Global Outcomes (KDIGO). The Kidney Disease: Improving Global Outcomes (KDIGO) committee was established to develop and disseminate guidelines for the diagnosis and treatment of chronic kidney disease [2]. The definition, classification and monitoring and prevention of chronic kidney disease developed by this organization in 2002 have been translated into Chinese and published [7]. Li Chunqing, Department of Nephrology, Wuxi Third People’s Hospital In China, a significant number of patients with chronic renal failure do not have access to renal replacement therapy, but incomplete statistics from the two major cities of Beijing and Shanghai in 2002 and 2003 show that about 4,000 new patients enter hemodialysis each year, indicating that there is a significant growth in chronic renal failure in China that cannot be ignored! The prevention and treatment of the huge ice block hidden under this iceberg is very weak. According to a questionnaire survey of 205 nephrologists working in tertiary hospitals (mainly teaching medicine) in 2004, 2/3 of kidney patients had blood creatinine over 2mg/dl and 1/4 of kidney patients had blood creatinine over 6mg/dl when they first visited the hospital, on the one hand, the patients were diagnosed too late, and on the other hand, the patients went to various hospitals (including quacks and charlatans) after the consultation. On the other hand, the patients not only do not receive systematic and comprehensive follow-up treatment, but also do not have reasonable control of renal function, blood pressure, hematocrit and other major indicators, and sometimes take some drugs that damage the function of kidney and other organs indiscriminately, which accelerates the degree of kidney and cardiovascular and other organ damage. Therefore, the nephrology community in China urgently needs to follow the international academic trends and keep up with the times to improve the understanding, clinical and research levels of chronic kidney disease: First, education should be strengthened. First of all, we need to enhance the education of nephrologists, general physicians and primary care physicians on the importance of chronic kidney disease and its prevention and treatment, the staging of chronic kidney disease, the assessment of GFR, the measurement of urine protein, and the specific contents, measures and targets of integrated treatment of chronic kidney disease. This task of continuing education requires the joint commitment of colleagues in the nephrology community, level by level, layer by layer. Continuing education and awareness is a long-term task. In 2002, another article analyzed the inadequate understanding of chronic kidney disease in the United States. In addition, it is important to educate and reach consensus with health administration and health insurance policy makers. Second, there is a need to change the current form of diagnosis and treatment and to establish a systematic follow-up and follow up system for chronic kidney disease. As far as possible, patients should not be allowed to drift blindly. In the current state of our medical system, it is difficult to treat patients in a planned, graded and stratified manner between hospitals at all levels. However, we should make efforts to try to establish systematic management and stratified and graded treatment for patients locally and in a certain area. Only in this way can the monitoring of renal function, the monitoring of cardiac and other systemic comorbidities, the systematic treatment of hypertension, anemia, nutrition, lipids, calcium and phosphorus metabolism and all aspects of bone disease in chronic kidney patients be put into practice so that every patient can benefit. It is recommended that the Nephrology Branch of the Chinese Medical Association regularly (every two or three years) investigate and analyze the status of attainment of the above-mentioned treatments in chronic kidney patients in China and the reasons for failure to attain them, and provide guidance. There is also a great deal of research work that needs to be done in the field of chronic kidney disease. For example, what is the prevalence and morbidity of patients in China? Who are the high-risk groups for chronic kidney disease in China? What is the appropriate formula for assessing GFR (eGFR) in China? Is it reasonable to define chronic kidney disease at three months? Our nephrologists need to investigate the normal value of GFR in Chinese adults according to their ethnicity, dietary characteristics, muscle development, etc., as well as the relationship between the decline of GFR and the emergence of complications, the appropriate time to consider dialysis, etc., to measure the defined value of CKD patient staging in China, in order to guide clinical work, and to establish a Chinese registry system for chronic kidney disease, dialysis, and transplantation in the near future, to name but a few topics. These topics are not to be mentioned. All of these topics need to be discussed in the nephrology community in China to enhance the unity and collaboration, and to present the views and opinions of our nephrologists based on facts through solid research work. The integrated measures for the prevention and treatment of chronic kidney disease are not only the promotion and use of certain new drugs and tests, but also the change of medical philosophy and working mode of nephrologists. We should not only be satisfied with contacting patients in the consultation room for ten minutes or in the ward for ten days, but also establish a tracking management and guidance system for patients; we should not only wait for patients in the hospital, but also go out of the hospital and look for early patients; we should not only pay attention to the combination of clinical and basic medicine to carry out laboratory research work, but also carry out interdisciplinary cooperation with health statistics and epidemiology to make a good job in the prevention and treatment of kidney disease. We should not only pay attention to the combination of clinical and basic medicine to carry out laboratory research, but also carry out interdisciplinary cooperation with health statistics and epidemiology, so as to make a good job in the prevention and treatment of kidney disease. Extracted from: www.med66.com