慢性肾脏病患者疾病管理课件.pptVIP

Anemia-Treatment Guidelines Goal Hgb 11-12 Recombinant erythropoeitin Epogen/Procrit 50-150 U/kg/wk SQ Darbopoetin alfa (ARANESP) Start 0.45mcg/kg SQ once every 2 weeks, usually dosed every three to four weeks when patient is stable in the therapeutic range Recent concerns re increased risk of cardiovascular events associated with an elevated Hgb in association with use of high doses of these products Iron Goal Ferritin 200, TSAT 20% Oral agents Chromagen: 33% iron Ferrous sulfate: 20% iron Niferex (Polysaccharide with Vit C): 150mg elemental iron Ferrous fumurate: 33% iron Ferrous gluconate (Fergon): 12% iron Oral agents do not work well, primarily b/o ill tolerated GI side effects Avoidance of acute exacerbation of function Volume depletion IV Radiographic contrast Gadolinium Aminoglycosides and amphoterecin NSAIDS/COX II inhibitors (Tordal) ACE-I/ARB in certain populations CyA / Tacrolimus in the transplant population Obstructive uropathy Stage 1: GFR 90 Stage 2: GFR 60-89 Stage 3: GFR 30-59 Stage 4: GFR 15-29 Stage 5: GFR 15 K-DOQI Action Plan for the Management of CKD Clinical evaluation Slowing Progression CVD Risk Reduction Replacement Therapy Symptom control preparation for replacement therapy Slowing Progression CVD Risk Reduction Treat Complication In Summary: Important Early Conservative Therapies ACE Inhibitor, Angiotensin II Receptor Antagonist, and Beta Blocker Therapy, to control HTN Adequate volume control with diuretics Early Treatment of hyperphosphatemia with Phosphate binders Early Treatment with Active Vitamin D Early Treatment with Erythropoietin/Darbepoetin (PROCRIT/ARANESP) Early Treatment with Iron Products Aggressive control of glucose levels in Diabetics THE END * * There are about 30 published definitions of CKD. The most accurate way to define chronic kidney disease is with a kidney biopsy. This is Kidney Let me start with some Pathology 101. This is healthy kidney. Note the ever-important glomerulus with normal c