2015年欧洲肾脏最佳临床实践关于糖尿病合并慢性肾脏病3b期或更高阶段临床管理指南.ppt

FIGURE 6: Dose recommendations in CKD. * ——《2型糖尿病合并慢性肾脏病患者口服降糖药用药原则中国专家共识》 * FIGURE 7: Impact of different classes of glycaemia-lowering drugs on different outcomes. * CHAPTER 3. ISSUES RELATED TO MANAGEMENT OF CARDIOVASCULAR RISK IN PATIENTS WITH DIABETES AND CKD STAGE 3B OR HIGHER * In patients with diabetes and CKD stage 3b or higher(eGFR 45 mL/min/1.73 m2) or on dialysis and with CAD, is percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or conservative treatment to be preferred? 3.1.1 We recommend not omitting coronary angiography with the sole intention of avoiding potential contrast-related deterioration of kidney function in patients with diabetes and CKD stage 3b or higher (eGFR45 mL/min) in whom a coronary angiography is indicated (1D). * In patients with diabetes and CKD stage 3b or higher(eGFR 45 mL/min/1.73 m2) or on dialysis and with CAD, is percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or conservative treatment to be preferred? 3.1.2 We recommend that optimal medical treatment should be considered as preferred treatment in patients with diabetes and CKD stage 3b–5 who have stable CAD, unless there are large areas of ischaemia or significant left main or proximal LAD lesions (1C). 3.1.3 We recommend that when a decision is taken to consider revascularization, CABG is preferred over PCI in patients with multivessel or complex (SYNTAX score 22) CAD (1C). * In patients with diabetes and CKD stage 3b or higher(eGFR 45 mL/min/1.73 m2) or on dialysis and with CAD, is percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or conservative treatment to be preferred? 3.1.4 We recommend that patients with diabetes and CKD stage 3b or higher (eGFR45 mL/min) who present with an acute coronaryevent should be treated no differently than patients with CKD stage 3b or higher (eGFR45 mL/min) without diabetes or patients with diabetes without CKD st