调查西藏地区慢性肾脏病(chronic kidney disease，CKD)管理现状，并探讨不同级别医院及医护人员在诊治与教育方面的差异，为制定高海拔高寒地区CKD防控策略及规范化管理提供依据。

以2025年9月参加基层医师CKD规范化培训的西藏地区医护人员为研究对象，开展横断面现场问卷调查。调查内容涉及CKD筛查、诊治与管理现状、护理与患者教育及医护的培训需求等内容。比较不同层级医院以及肾脏专科与非肾脏专科医护人员在CKD诊疗及管理方面的差异。

共收集有效问卷54份，受访者所在医院海拔中位数为3 650 m，79.6%来自三级医院，68.5%为从事肾内科专科工作。西藏地区医院CKD相关常规检测(血常规、血糖、血脂、血清肌酐、尿常规)开展率均超过90%，尿微量白蛋白/肌酐比值(urine microalbumin-to-creatine ratio, UACR)开展率为74.1%。三级医院对UACR(χ²＝10.864，P<0.01)、铁蛋白(χ²＝6.642，P＝0.01)和促红细胞生成素(χ²＝5.130，P＝0.024)的检测能力优于基层医疗机构(含二级、一级医院)。钙通道阻滞剂为肾性高血压最常用的降压药(37.4%)，肾素-血管紧张素-醛固酮系统抑制剂应用比例为29.6%。贫血管理方面，31.5%受访者表示在高原地区确诊"真性"贫血存在困难，肾内科专科医生使用静脉铁剂(χ²＝4.598，P＝0.032)、红细胞生成刺激剂(χ²＝11.977，P<0.01)和缺氧诱导因子-脯氨酸羟化酶抑制剂(χ²＝12.362，P<0.01)等药物的经验多于非肾脏专科。患者教育环节存在不足，仅38.9%医务人员能开展系统教育，51.5%提供口头指导，护理工作主要受限于技能培训缺乏(37.0%)和人力不足(35.2%)。多学科协作方面，66.1%医院具备线上/线下会诊渠道。医护人员培训需求集中在指南解读(75.9%)、营养管理(72.2%)和CKD并发症的规范处理(68.5%)。

在西藏地区，与三级医院相比，基层医疗机构在CKD管理中的检测能力相对不足；西藏地区医疗机构在继续教育培训和护理资源配置方面需要进一步加强或优化。

To investigate the current management status of chronic kidney disease (CKD) in the Tibet region and explore the disparities in diagnosis, treatment, and education among hospitals of different levels and healthcare professionals, so as to provide a basis for formulating prevention and control strategies and standardized management for CKD in high-altitude and alpine regions.

A cross-sectional questionnaire-based survey was conducted among healthcare professionals from the Tibet region who participated in CKD standardized training for primary care physicians in September 2025. The survey covered CKD screening, current status of diagnosis, treatment and management, nursing care, and patient education, as well as the training needs of professionals. Disparities in diagnosis, treatment, and management of CKD between hospitals of different levels and between nephrology and non-nephrology staff were compared.

A total of 54 valid questionnaires were collected. The average altitude of the hospitals where the respondents worked was 3, 650 meters. Of the respondents, 79.6% were from tertiary hospitals, and 68.5% were engaged in nephrology practice. The availability of routine CKD-related tests (complete blood count, blood glucose, blood lipids, serum creatinine, and urinalysis) in hospitals of the Tibet region exceeded 90%, while the availability of the urine microalbumin-to-creatinine ratio (UACR) test was 74.1%. Tertiary hospitals demonstrated superior capability in detecting UACR (χ²=10.864, P<0.01), ferritin (χ²=6.642, P=0.01), and erythropoietin (χ²=5.130, P=0.024) compared to primary care institutions (including secondary and primary hospitals). Calcium channel blockers were the most frequently used antihypertensive agents for renal hypertension (37.4%), followed by renin-angiotensin-aldosterone system inhibitors (29.6%). Regarding anemia management, 31.5% of respondents reported difficulties in diagnosing "true" anemia in high-altitude regions. Nephrologists demonstrated more experience in using intravenous iron (χ²=4.598, P=0.032), erythropoiesis-stimulating agents (χ²=11.977, P<0.01), and hypoxia-inducible factor prolyl hydroxylase inhibitors (χ²=12.362, P<0.01) compared to non-nephrology staff. Deficiencies were observed in patient education. Only 38.9% of healthcare workers were able to provide systematic education, while 51.5% offered verbal guidance. Nursing practice was mainly constrained by a lack of skills training (37.0%) and insufficient manpower (35.2%). In terms of multidisciplinary collaboration, 66.1% of the hospitals had access to online or offline consultation channels. The training needs of healthcare professionals focused primarily on guideline interpretation (75.9%), nutritional management (72.2%), and the standardized management of CKD complications (68.5%).

In the Tibet region, primary care institutions demonstrated relatively limited detection capabilities in CKD management compared to tertiary hospitals. Furthermore, continuing education and nursing resource allocation in local healthcare facilities require further strengthening or optimization.