如何减缓慢性肾脏疾病的恶化.pptVIP

* * * A meta-analysis of a number of small sized, controlled trials: HMG-CoA reductase inhibitors helped to preserve kidney function. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 慢性腎臟疾病患者5年的臨床預後 End point CKD stage 2 (n = 1741) CKD stage 3 (n = 11,278) CKD stage 4 (n = 777) 惡化至尿毒症 須洗腎或換腎 1.1% 1.3% 19.9% 死亡 19.5% 24.3% 45.7% Arch Intern Med 2004; 164: 659-663 Normal Increased risk ASCVD LVH ASCVD events CHF CVD death Screening for CVD risk factors 篩檢心血管疾病, 減少心血管疾病危險因子 減緩惡化, 預防心血管事件 診斷與治療心血管疾病, 預防心血管疾病復發 診斷與治療心衰竭, 機械輔助性替代療法 心臟移植 Complications CKD 患者心血管疾病介入治療的模式 Am J Kidney Dis 39: Part 6, 2002 (suppl 1) 腎臟功能應多久追蹤一次？ CKD Stage GFR (ml/min/1.73 m2) Frequency 1 90 Annual 2 60-89 Annual 3 (stable) 30-59 Annual 3 (new/progressive) 30-59 6-monthly 4 (stable) 15-29 6-monthly 4 (new/progressive) 15-29 3-monthly 5 15 3-monthly 至少 CKD 病患何時應該轉介給腎臟專科醫師? Immediate referral Malignant hypertension Hyperkalemia (K 7.0 mmol/L) Rapid deterioration of renal function Newly-detected stage 5 CKD Urgent referral Proteinuria with edema and low serum albumin (nephrotic syndrome) Routine referral Dipstick proteinuria present and urine protein/creatinine ratio 100 mg/day Dipstick proteinuria and microscopic hematuria present Macroscopic hematuria but urological tests negative CKD stage 4 Thank You for Your Attention! Recommended antihypertensive regimens (1) Nonpharmacologic therapy of hypertension Initial pharmacologic therapy of hypertension (1) low-dose ACEI therapy (starting dose recommended by manufacturer) plus dietary salt restriction (2) moderate-dose ACEI therapy (2 to 4 times the recommended starting dose) plus dietary salt restriction (3) moderate-dose ACEI therapy plus dietary salt restriction plus diuretic therapy Hebert LA et al. Kidney Int 2001; 59: 1211-26 MRFIT Recommended antihypertensive regimens (2) Triple antihypertensive therapy ACEI, diuretic, and nondihydropyridine calcium channel