从KDIGO2012年慢性肾脏病的评估与管理指南谈CKD-CVD.ppt

从“KDIGO2012慢性肾脏病的评估与管理”指南谈CKD-CVD 广州中医药大学 第一附属医院 王超 背景介绍 KDIGO：Kidney Disease: Improving Global Outcomes(改善全球肾脏病预后组织) CKD-CVD:Chronic Kidney Disease-Cardiovascular Disease 主要内容 1、CKD的定义与分级 2、CVD的临床表现 3、CKD与CVD的相互影响 4、CKD-CVD的发病机制 5、CKD-CVD的管理与干预 1.1 CKD定义 1.2 CKD分级 1.2 CKD分级 1.2 CKD分级 1.2 CKD分级 1.2 CKD分级 2. CVD的临床表现 3. CKD与CVD的相互影响 3.1 CKD的流行病学特点 3.2 CKD-CVD的发病率 3.3 CKD对CVD的相互影响 4. CKD-CVD的发病机制 5. CKD-CVD的管理与干预 1. 可逆危险因素的控制 2. RASS抑制剂 3. 他汀类 4. 促红素 5. CKD-CVD的管理与干预 5. CKD-CVD的管理与干预 5. CKD-CVD的管理与干预 5. CKD-CVD的管理与干预 5. CKD-CVD的管理与干预 5. CKD-CVD的管理与干预 小结 1、KDIGO指南CKD分期在GFR分期基础上增加白蛋白尿分期，在全因死亡基础上增加心血管死亡终点； 2、CKD是CVD的独立危险因素，CKD患者CVD发病风险和死亡风险高，CVD是CKD患者的最常见死因； 3、CKD-CVD的发病机制复杂； 4、积极干预CKD-CVD患者。 * 高血压 蛋白尿 低蛋白血症 高凝血症 糖尿病 血脂异常 肥胖 妊娠 Hsu SI, et al. Kidney Int .2000;57:1818–35. Donadio JV, et al. Nephrol Dial Transplant .2002;17:1197–203. Rauta V, et al. Clin Nephrol .2002; 58: 85–94. Bonnet F,et al.Am J Kidney Dis 2001;37:720–27. 高蛋白饮食 吸烟 食盐摄入不当 尿毒症毒素 细胞增殖 炎细胞浸润 其他因素 CKD对心血管的影响---可控的进展因素 5. CKD-CVD的管理与干预 指南关于血压/尿蛋白干预的建议 Assign cause of CKD based on presence or absence of systemic disease and the location within the kidney of observed or presumed pathologic-anatomic findings. Cause is included so as to ensure that clinicians are alerted to the fact that CKD is not a diagnosis in and of itself, and that the assignment of cause is important for prognostication and treatment. There is wide geographic variation in the cause of kidney disease: In developed countries, hypertension and diabetes are the most frequent causes of CKD, especially in the elderly. In populations with a high prevalence of diabetes and hypertension, it can be difficult to distinguish CKD due to these disorders from CKD due to other disorders. In other countries, other causes of CKD may be as frequent as hypertension and diabetes (for example, glomerular disease in East Asia) or co-exist with them. Specialized diagnostic testing, such as kidney biopsy or invasive imaging studies are per