心肾联合损害诊治中面临的一些问题骆雷鸣课件.ppt

Logistic regression analyses show that creatinine level is the strongest predictor of mortality. Nevertheless, when creatinine is controlled for, chronic oral diuretic use is still significantly associated with significantly higher mortality. Thus, creatinine level and chronic oral diuretic use are independent predictors of mortality. UF: n = 72 90 69 47 86 71 75 66 SC: n = 84 91 75 52 90 75 67 62 P 0.05 at all time points Costanzo MR, et al. J Am Coll Cardiol. 2007;49:675-683. 超滤与静脉利尿剂对住院 ADHF 疗效比较UNLOAD Trial-安全性（Scr) 肾功能评价方法及 CKD 诊断用语的应用 CKD 的自然进程与心血管事件 心力衰竭与肾功能恶化 心肾综合征时的贫血与 EPO、铁剂的应用 利尿剂与肾功能及预后的关系 利尿剂抵抗与处理 重组人 B 型利钠肽的应用及价值 血液滤过技术在心衰治疗中的应用 小结 nature clinical practice NEPHROLO GY　2009,5(1): 1 The British Journal of Cardiology 2008 15 (6): 290-1 THANKS FOR ATTENDING Most Common IV Medications All Enrolled Discharges (n=105,388) 2001.10—2004.01 IV Diuretic Use 64% of patients are given an IV diuretic only Common diuretics used include: Furosemide 84% Bumetanide 7% Torsemide 2% The ADHERE Registry 2nd Quarter 2003 National Benchmark Report; Scios Inc. 88% 64% 0 10 20 30 40 50 60 70 80 90 Percent Given IV Diuretic Given IV Diuretic Alone Saluresis and Diuresis Complications of Diuretic Therapy for HF GFR = glomerular filtration rate; PRA = plasma renin activity. Kaplan NM. Treatment of hypertension: drug therapy in clinical hypertension. In: Kaplan NM, Lieberman E, Neal WW, eds. Clinical Hypertension. 1994:203. ↑ Distal Ca++Reabsorption ↓ Plasma Volume ↓ Uric AcidClearance Diuretic Therapy ↓ Cardiac Output ↓ Renal Blood Flow Hyponatremia ↑ PRA ↓ GFR ↑ ProximalReabsorption ↑ Aldosterone Kaliuresis Hypokalemia Glucose Intolerance Hypocalcemia Hyperuricemia ↓ CalciumClearance Pre-renalAzotemia Postural Hypotension ↓ Renal Reabsorption of Na (and Mg) Hypomagnesemia Bayliss J et al. Br Heart J. 1987;57:17–22. Marked Activation of the RAAS by Loop