{"id":27709,"date":"2024-03-26T04:54:22","date_gmt":"2024-03-26T04:54:22","guid":{"rendered":"https:\/\/zydq.1006ss.com\/?p=27709"},"modified":"2024-03-26T04:54:22","modified_gmt":"2024-03-26T04:54:22","slug":"%e9%87%8d%e7%a3%85%ef%bc%81kdigo-2024%e7%89%88ckd%e8%af%84%e4%bc%b0%e5%92%8c%e7%ae%a1%e7%90%86%e6%8c%87%e5%8d%97%e5%8f%91%e5%b8%83-%e5%bb%b6%e7%bc%93ckd%e8%bf%9b%e5%b1%95%e7%af%87","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=27709","title":{"rendered":"\u91cd\u78c5\uff01KDIGO 2024\u7248CKD\u8bc4\u4f30\u548c\u7ba1\u7406\u6307\u5357\u53d1\u5e03\u2014\u2014\u5ef6\u7f13CKD\u8fdb\u5c55\u7bc7\uff08\u672a\u5b8c\u5f85\u7eed\uff09"},"content":{"rendered":"

\u7f16\u8005\u6309<\/p>\n

3\u670813\u65e5\uff0c\u65f6\u969412\u5e74\uff0c\u6539\u5584\u5168\u7403\u80be\u810f\u75c5\u9884\u540e\u7ec4\u7ec7\uff08KDIGO\uff09\u91cd\u78c5\u53d1\u5e03\u6162\u6027\u80be\u810f\u75c5\uff08CKD\uff09\u8bc4\u4f30\u548c\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\uff08\u4e0b\u6587\u7b80\u79f0\u201c2024\u7248\u6307\u5357\u201d\uff09[1]<\/sup>\uff0c\u5e76\u540c\u6b65\u53d1\u8868\u5728Supplement to Kidney International\u6742\u5fd7\u4e0a\u30022024\u7248\u6307\u5357\u662f\u5bf92012\u7248\u6307\u5357\u7684\u66f4\u65b0\uff0c\u4e3b\u8981\u5185\u5bb9\u6db5\u76d6CKD\u8bc4\u4f30\u4e0e\u5206\u7c7b\u3001CKD\u60a3\u8005\u7684\u98ce\u9669\u8bc4\u4f30\u3001\u75be\u75c5\u53ca\u5176\u76f8\u5173\u5e76\u53d1\u75c7\u7ba1\u7406\u3001\u7528\u836f\u7ba1\u7406\u4ee5\u53ca\u5728\u4e0d\u540c\u4e34\u5e8a\u73af\u5883\u4e2d\u63d0\u4f9b\u4ee5\u60a3\u8005\u4e3a\u4e2d\u5fc3\u7684\u62a4\u7406\u7b56\u7565\u3002\u6b64\u5916\uff0c2024\u7248\u6307\u5357\u66f4\u65b0\u4e86\u4f30\u7b97\u7684\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08eGFR\uff09\u548c\u86cb\u767d\u5c3f\u7684\u6d4b\u91cf\u65b9\u6cd5\u3001CKD\u98ce\u9669\u9884\u6d4b\u65b9\u7a0b\u7684\u4f7f\u7528\uff0c\u4ee5\u53ca\u9488\u5bf9\u4e2a\u4f53\u60a3\u8005\u9700\u6c42\u91cf\u8eab\u5b9a\u5236\u7684\u80be\u810f\u548c\u5fc3\u8840\u7ba1\u98ce\u9669\u6cbb\u7597\u5efa\u8bae\u3002\u8be5\u6307\u5357\u7684\u66f4\u65b0\u4e3a\u4e34\u5e8a\u5b9e\u8df5\u95ee\u9898\u63d0\u4f9b\u660e\u786e\u548c\u7b80\u660e\u7684\u6307\u5bfc\u5efa\u8bae\uff0c\u4ece\u800c\u6539\u5584\u5168\u7403CKD\u9884\u540e\uff0c\u5b9e\u73b0\u4eba\u4eba\u4eab\u53d7\u5065\u5eb7\u80be\u810f\u3002<\/p>\n

2024\u7248\u6307\u5357\u7531\u52a0\u62ff\u5927\u4e0d\u5217\u98a0\u54e5\u4f26\u6bd4\u4e9a\u5927\u5b66Adeera Levin\u6559\u6388\u548c\u82f1\u56fd\u4e1c\u80af\u7279\u533b\u9662\u5927\u5b66Paul Stevens\u6559\u6388\u5171\u540c\u4e3b\u6301\u66f4\u65b0\u3002Paul Stevens\u6559\u6388\u5728\u65b0\u7248\u6307\u5357\u53d1\u5e03\u7684\u65b0\u95fb\u7a3f\u4e2d\u63d0\u5230\uff1a\u201c\u4eba\u4eec\u8d8a\u6765\u8d8a\u6e05\u695a\u5730\u8ba4\u8bc6\u5230CKD\u662f\u4e00\u4e2a\u5168\u7403\u6027\u7684\u516c\u5171\u536b\u751f\u95ee\u9898\u3002\u5c06CKD\u60a3\u8005\u7eb3\u5165\u4e34\u5e8a\u8bd5\u9a8c\u5df2\u7ecf\u6781\u5927\u7a0b\u5ea6\u5730\u4e3a\u65e2\u5f80\u4e0d\u5b58\u5728\u7684\u62a4\u7406\u548c\u6cbb\u7597\u65b9\u6cd5\u63d0\u4f9b\u4e86\u8bc1\u636e\u57fa\u7840\u3002\u8d8a\u6765\u8d8a\u590d\u6742\u7684\u8bca\u65ad\u5de5\u5177\u548c\u6280\u672f\u7684\u8fdb\u6b65\u8868\u660e\uff0c\u6211\u4eec\u6b63\u5728\u89c1\u8bc1\u80be\u810f\u75c5\u5b66\u7684\u65b0\u65f6\u4ee3\u3002\u201d\u672c\u671f\u5bf9\u6307\u5357\u7b2c\u4e09\u7ae0\u201c\u5ef6\u7f13CKD\u8fdb\u5c55\u53ca\u5176\u5e76\u53d1\u75c7\u7ba1\u7406\u201d\u7684\u76f8\u5173\u63a8\u8350\u548c\u5b9e\u8df5\u8981\u70b9\u8fdb\u884c\u6574\u7406\u3002<\/p>\n<\/p>\n

\u7b2c\u4e09\u7ae0\uff1a\u5ef6\u7f13CKD\u8fdb\u5c55\u53ca\u5176\u5e76\u53d1\u75c7\u7ba1\u7406<\/p>\n

\uff08Delaying CKD progression and managing its complications\uff09<\/p>\n

3.1 CKD\u7684\u6cbb\u7597\u548c\u98ce\u9669\u7ba1\u7406 <\/p>\n

\u5b9e\u8df5\u8981\u70b93.1.1\uff1a\u5bf9CKD\u60a3\u8005\u91c7\u53d6\u7efc\u5408\u6cbb\u7597\u7b56\u7565\uff0c\u4ee5\u51cf\u5c11CKD\u8fdb\u5c55\u53ca\u5176\u76f8\u5173\u5e76\u53d1\u75c7\u98ce\u9669\uff08\u56fe1\uff09\u3002 <\/p>\n

\u56fe1. CKD\u7684\u6cbb\u7597\u548c\u98ce\u9669\u7ba1\u7406<\/p>\n

3.2\u751f\u6d3b\u65b9\u5f0f\u56e0\u7d20 <\/p>\n

\u5b9e\u8df5\u8981\u70b93.2.1\uff1a\u9f13\u52b1CKD\u60a3\u8005\u8fdb\u884c\u4e0e\u5fc3\u8840\u7ba1\u5065\u5eb7\u3001\u8010\u53d7\u6027\u548c\u865a\u5f31\u7a0b\u5ea6\u76f8\u9002\u5e94\u7684\u4f53\u80b2\u6d3b\u52a8\uff1b\u8fbe\u5230\u6700\u4f73\u7684\u4f53\u91cd\u6307\u6570\uff08BMI\uff09\uff1b\u6212\u70df\u3002 3.2.1\u6212\u70df [\u65e0\u5177\u4f53\u7684\u5efa\u8bae\u6216\u5b9e\u8df5\u8981\u70b9]3.2.2.\u4f53\u80b2\u8fd0\u52a8\u548c\u6700\u4f73\u4f53\u91cd2024\u7248\u6307\u5357\u5de5\u4f5c\u7ec4\u540c\u610fKDIGO 2022\u6162\u6027\u80be\u810f\u75c5\u60a3\u8005\u7cd6\u5c3f\u75c5\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u4e2d\u6240\u6709\u4e0e\u4f53\u80b2\u8fd0\u52a8\u6709\u5173\u7684\u5efa\u8bae\u548c\u5b9e\u8df5\u8981\u70b9\uff0c\u5e76\u8ba4\u4e3a\u5e94\u8be5\u6269\u5c55\u5230\u6240\u6709CKD\u6210\u4eba\u60a3\u8005\u3002\u540c\u65f6\u63d0\u9192\u6ce8\u610f\u4ee5\u4e0b\u58f0\u660e\uff1a <\/p>\n

\u63a8\u83503.2.2.1\uff1a\u63a8\u8350CKD\u60a3\u8005\u8fdb\u884c\u4e2d\u7b49\u5f3a\u5ea6\u7684\u4f53\u80b2\u8fd0\u52a8\uff0c\u6bcf\u5468\u81f3\u5c11150\u5206\u949f\uff0c\u6216\u8fbe\u5230\u4e0e\u5176\u5fc3\u8840\u7ba1\u548c\u8eab\u4f53\u8010\u53d7\u6027\u76f8\u9002\u5e94\u7684\u6c34\u5e73\uff081D\uff09\u3002 <\/p>\n

\u5b9e\u8df5\u8981\u70b93.2.2.1\uff1a\u5bf9\u4f53\u80b2\u8fd0\u52a8\u7684\u5efa\u8bae\u5e94\u5f53\u8003\u8651\u60a3\u8005\u5e74\u9f84\u3001\u79cd\u65cf\u80cc\u666f\u3001\u662f\u5426\u5b58\u5728\u5176\u4ed6\u5408\u5e76\u75c7\u548c\u8d44\u6e90\u7684\u53ef\u53ca\u6027\u3002 \u5b9e\u8df5\u8981\u70b93.2.2.2\uff1a\u5e94\u5efa\u8baeCKD\u60a3\u8005\u907f\u514d\u4e45\u5750\u4e0d\u52a8\u3002 \u5b9e\u8df5\u8981\u70b93.2.2.3\uff1a\u5bf9\u4e8e\u8dcc\u5012\u98ce\u9669\u8f83\u9ad8\u7684\u60a3\u8005\uff0c\u533b\u7597\u4fdd\u5065\u4eba\u5458\u5e94\u63d0\u4f9b\u6709\u5173\u4f53\u80b2\u8fd0\u52a8\u5f3a\u5ea6\uff08\u4f4e\u3001\u4e2d\u7b49\u6216\u5267\u70c8\u8fd0\u52a8\uff09\u548c\u8fd0\u52a8\u7c7b\u578b(\u6709\u6c27\u8fd0\u52a8\u3001\u6297\u963b\u529b\u8fd0\u52a8\u6216\u4e8c\u8005\u517c\u6709)\u7684\u5efa\u8bae\u3002\u5b9e\u8df5\u8981\u70b93.2.2.4\uff1a\u533b\u751f\u5e94\u8003\u8651\u5efa\u8bae\/\u9f13\u52b1\u5408\u5e76\u80a5\u80d6\u7684CKD\u60a3\u8005\u51cf\u80a5\u3002  \u5b9e\u8df5\u8981\u70b93.2.2.5\uff1a\u9f13\u52b1CKD\u513f\u7ae5\u60a3\u8005\u8fbe\u5230\u4e16\u754c\u536b\u751f\u7ec4\u7ec7\uff08WHO\uff09\u5efa\u8bae\u7684\u4f53\u80b2\u8fd0\u52a8\u6c34\u5e73\uff08\u5373\u6bcf\u5929\u226560\u5206\u949f\uff09\uff0c\u4ee5\u83b7\u5f97\u5065\u5eb7\u7684\u4f53\u91cd\u3002\uff08\u513f\u79d1\u6ce8\u610f\u4e8b\u9879\uff09 <\/p>\n

3.3\u996e\u98df <\/p>\n

\u5b9e\u8df5\u8981\u70b93.3.1\uff1a\u5efa\u8baeCKD\u60a3\u8005\u91c7\u7528\u5065\u5eb7\u548c\u591a\u6837\u5316\u7684\u996e\u98df\uff0c\u690d\u7269\u6027\u98df\u7269\u7684\u6444\u5165\u91cf\u5e94\u8f83\u52a8\u7269\u6027\u98df\u7269\u6444\u5165\u91cf\u9ad8\uff0c\u540c\u65f6\u51cf\u5c11\u8d85\u52a0\u5de5\u98df\u54c1\u7684\u6444\u5165\u91cf\u3002 \u5b9e\u8df5\u8981\u70b93.2\uff1a\u80be\u810f\u8425\u517b\u5e08\u6216\u88ab\u8ba4\u53ef\u7684\u8425\u517b\u5e08\u6839\u636eCKD\u60a3\u8005\u4e2a\u4eba\u9700\u6c42\u3001CKD\u4e25\u91cd\u7a0b\u5ea6\u548c\u5176\u4ed6\u5408\u5e76\u75c7\u60c5\u51b5\uff0c\u8bc4\u4f30\u60a3\u8005\u94a0\u3001\u78f7\u3001\u94be\u548c\u86cb\u767d\u8d28\u7684\u6444\u5165\u91cf\u3002 3.3.1\u86cb\u767d\u8d28\u6444\u5165\u91cf<\/p>\n

\u63a8\u83503.3.1.1\uff1a\u63a8\u8350CKD G3~G5\u6210\u4eba\u60a3\u8005\u86cb\u767d\u8d28\u6444\u5165\u91cf\u7ef4\u63010.8 g\/kg\/d\uff082C\uff09\u3002\u5b9e\u8df5\u8981\u70b93.3.1.1\uff1a\u5bf9\u6709\u8fdb\u5c55\u98ce\u9669\u7684CKD\u6210\u4eba\u60a3\u8005\u907f\u514d\u86cb\u767d\u8d28\u6444\u5165\u91cf\u8fc7\u9ad8\uff08>1.3 g\/kg\/d\uff09\u3002 \u5b9e\u8df5\u8981\u70b93.3.1.2\uff1a\u5bf9\u4e8e\u613f\u610f\u3001\u6709\u6761\u4ef6\u4e14\u6709\u80be\u8870\u7aed\u98ce\u9669\u7684CKD\u6210\u4eba\u60a3\u8005\uff0c\u8003\u8651\u5728\u5bc6\u5207\u76d1\u7763\u4e0b\uff0c\u5904\u65b9\u6781\u4f4e\u86cb\u767d\u8d28\u996e\u98df\uff080.3~0.4 g\/kg\/d\uff09\uff0c\u540c\u65f6\u8865\u5145\u5fc5\u9700\u6c28\u57fa\u9178\u6216\u916e\u9178\u7c7b\u4f3c\u7269\uff08\u6700\u9ad80.6 g\/kg\/d)\u3002 \u5b9e\u8df5\u8981\u70b93.3.1.3\uff1a\u5bf9\u4e8e\u4ee3\u8c22\u4e0d\u7a33\u5b9a\u7684CKD\u60a3\u8005\u4e0d\u5b9c\u4f4e\u6216\u6781\u4f4e\u86cb\u767d\u8d28\u996e\u98df\u3002 \u5b9e\u8df5\u8981\u70b93.3.1.4\uff1a\u4e0d\u5b9c\u9650\u5236CKD\u513f\u7ae5\u60a3\u8005\u7684\u86cb\u767d\u8d28\u6444\u5165\u91cf\u3002CKD G2~G5\u513f\u7ae5\u60a3\u8005\u86cb\u767d\u8d28\u548c\u80fd\u91cf\u7684\u6444\u5165\u91cf\u5e94\u5728\u5065\u5eb7\u513f\u7ae5\u6b63\u5e38\u8303\u56f4\u7684\u4e0a\u9650\uff0c\u4ee5\u4fc3\u8fdb\u60a3\u513f\u6700\u4f73\u751f\u957f\u3002\uff08\u513f\u79d1\u6ce8\u610f\u4e8b\u9879\uff09  \u5b9e\u8df5\u8981\u70b93.3.1.5\uff1a\u5bf9\u4e8e\u8eab\u4f53\u865a\u5f31\u548c\u60a3\u9aa8\u9abc\u808c\u51cf\u5c11\u75c7\u7b49\u6f5c\u5728\u75be\u75c5\u7684\u8001\u5e74CKD\u60a3\u8005\uff0c\u5e94\u8003\u8651\u66f4\u9ad8\u7684\u86cb\u767d\u8d28\u548c\u80fd\u91cf\u6444\u5165\u76ee\u6807\u3002\uff08\u8001\u5e74\u6ce8\u610f\u4e8b\u9879\uff09 3.3.2\u94a0\u6444\u5165\u91cf 2024\u7248\u6307\u5357\u5de5\u4f5c\u7ec4\u540c\u610fKDIGO 2022\u6162\u6027\u80be\u810f\u75c5\u60a3\u8005\u7cd6\u5c3f\u75c5\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u4ee5\u53caKDIGO 2021\u6162\u6027\u80be\u810f\u75c5\u8840\u538b\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u4e2d\u7684\u5efa\u8bae\u3002<\/p>\n

\u63a8\u83503.3.2.1\uff1a\u63a8\u8350CKD\u60a3\u8005\u6bcf\u5929\u94a0\u6444\u5165\u91cf<2 g\uff08\u6216<90 mmol\u94a0\uff0c\u6216<5 g\u6c2f\u5316\u94a0\uff09\uff082C\uff09\u3002\u5b9e\u8df5\u8981\u70b93.3.2.1\uff1a\u996e\u98df\u4e2d\u94a0\u76d0\u9650\u5236\u901a\u5e38\u4e0d\u9002\u7528\u4e8e\u94a0\u6d88\u8017\u6027\u80be\u75c5\u60a3\u8005\u3002  \u5b9e\u8df5\u8981\u70b93.3.2.2\uff1aCKD\u513f\u7ae5\u60a3\u8005\u6bcf\u65e5\u94a0\u6444\u5165\u91cf\u5e94\u57fa\u4e8e\u5e74\u9f84\u8fdb\u884c\u63a8\u8350\u3002 <\/p>\n

3.4\u8840\u538b\u63a7\u5236 <\/p>\n

2024\u7248\u6307\u5357\u5de5\u4f5c\u7ec4\u540c\u610fKDIGO 2021\u6162\u6027\u80be\u810f\u75c5\u8840\u538b\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u7684\u5efa\u8bae\uff0c\u8be5\u6307\u5357\u9f13\u52b1\u4e2a\u4f53\u5316\u8840\u538b\u76ee\u6807\uff0c\u5e76\u6839\u636e\u5e74\u9f84\u3001\u5408\u5e76\u5fc3\u8840\u7ba1\u75be\u75c5\uff08CVD\uff09\u6216\u5176\u4ed6\u5408\u5e76\u75c7\u60c5\u51b5\u3001CKD\u8fdb\u5c55\u98ce\u9669\u4ee5\u53ca\u5bf9\u6cbb\u7597\u7684\u8010\u53d7\u6027\u9009\u62e9\u836f\u7269\u3002\u65b0\u7248\u6307\u5357\u5f3a\u8c03\u4ee5\u4e0b\u6307\u5bfc\u610f\u89c1\uff1a <\/p>\n

\u63a8\u83503.4.1\uff1a\u5728\u53ef\u8010\u53d7\u7684\u60c5\u51b5\u4e0b\uff0c\u63a8\u8350CKD\u5408\u5e76\u9ad8\u8840\u538b\u6210\u4eba\u60a3\u8005\u6536\u7f29\u538b\uff08SBP\uff09\u63a7\u5236\u76ee\u6807<120 mmHg\uff082B\uff09\u3002 \u5b9e\u8df5\u8981\u70b93.4.1\uff1a\u5bf9\u4e8e\u8eab\u4f53\u865a\u5f31\u3001\u8dcc\u5012\u548c\u9aa8\u6298\u98ce\u9669\u9ad8\u3001\u9884\u671f\u5bff\u547d\u77ed\u6216\u6709\u75c7\u72b6\u6027\u4f53\u4f4d\u6027\u4f4e\u8840\u538b\u7684\u60a3\u8005\uff0c\u53ef\u4ee5\u8003\u8651\u9002\u5f53\u653e\u5bbd\u964d\u538b\u6cbb\u7597\u76ee\u6807\u3002 <\/p>\n

\u63a8\u83503.4.2\uff1a\u5bf9\u4e8eCKD\u513f\u7ae5\u60a3\u8005\uff0c\u63a8\u8350\u901a\u8fc7\u52a8\u6001\u8840\u538b\u76d1\u6d4b\uff08ABPM\uff09\u8bc4\u4f3024\u5c0f\u65f6\u5e73\u5747\u52a8\u8109\u538b\uff08MAP\uff09\uff082C\uff09\u3002\u5b9e\u8df5\u8981\u70b93.4.2\uff1a\u5efa\u8baeCKD\u513f\u7ae5\u60a3\u8005\u6bcf\u5e74\u76d1\u6d4b\u4e00\u6b21ABPM\uff0c\u6bcf3~6\u4e2a\u6708\u76d1\u6d4b\u4e00\u6b21\u6807\u51c6\u5316\u8bca\u5ba4\u8840\u538b\u3002 \u5b9e\u8df5\u8981\u70b93.4.3\uff1a\u82e5CKD\u513f\u7ae5\u60a3\u8005\u672a\u76d1\u6d4bABPM\uff0c\u6d4b\u91cf\u8bca\u5ba4\u8840\u538b\u4e5f\u662f\u5408\u7406\u7684\uff0c\u5728\u6cbb\u7597\u65b9\u6848\u9a71\u52a8\u4e0b\u8fbe\u5230\u5e74\u9f84\u3001\u6027\u522b\u548c\u8eab\u9ad8\u5339\u914d\u8840\u538b\u7684\u7b2c50~75\u767e\u5206\u4f4d\uff0c\u9664\u975e\u8fbe\u5230\u8fd9\u4e00\u76ee\u6807\u53d7\u5230\u4f4e\u8840\u538b\u4f53\u5f81\u6216\u75c7\u72b6\u7684\u9650\u5236\u3002<\/p>\n

3.5\u8840\u7cd6\u63a7\u5236 <\/p>\n

\u6709\u5173\u5177\u4f53\u7684\u5efa\u8bae\u3001\u5b9e\u8df5\u8981\u70b9\u548c\u7814\u7a76\u63a8\u8350\uff0c\u8bf7\u53c2\u8003KDIGO 2022\u6162\u6027\u80be\u810f\u75c5\u60a3\u8005\u7cd6\u5c3f\u75c5\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u3002 <\/p>\n

3.6\u80be\u7d20-\u8840\u7ba1\u7d27\u5f20\u7d20\u7cfb\u7edf\u6291\u5236\u5242\uff08RASi\uff09 <\/p>\n

2024\u7248\u6307\u5357\u5de5\u4f5c\u7ec4\u5f3a\u8c03\u4e86KDIGO 2021\u6162\u6027\u80be\u810f\u75c5\u8840\u538b\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u4e2d\u7684\u63a8\u8350\uff0c\u5e76\u4eceKDIGO 2021\u6162\u6027\u80be\u810f\u75c5\u8840\u538b\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u548cKDIGO 2022\u6162\u6027\u80be\u810f\u75c5\u60a3\u8005\u7cd6\u5c3f\u75c5\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u4e2d\u9009\u62e9RASi\u6cbb\u7597\u7684\u5b9e\u8df5\u8981\u70b9\u30022024\u7248\u6307\u5357\u5de5\u4f5c\u7ec4\u63d0\u51fa\u4e86\u4e00\u4e9b\u5efa\u8bae\uff0c\u5bf9\u6ca1\u6709\u9ad8\u8840\u538b\u7684CKD\u60a3\u8005\u4e5f\u9002\u7528\u3002\u5173\u952e\u63a8\u8350\u548c\u5b9e\u8df5\u8981\u70b9\u5982\u4e0b\uff1a <\/p>\n

\u63a8\u83503.6.1\uff1a\u5bf9\u4e8eCKD\u5408\u5e76\u767d\u86cb\u767d\u5c3f\u91cd\u5ea6\u589e\u52a0\uff08G1-G4\u3001A3\uff09\u4e14\u65e0\u7cd6\u5c3f\u75c5\u7684\u60a3\u8005\uff0c\u63a8\u8350\u8d77\u59cbRASi\uff08\u8840\u7ba1\u7d27\u5f20\u7d20\u8f6c\u6362\u9176\u6291\u5236\u5242[ACEi]\u6216\u8840\u7ba1\u7d27\u5f20\u7d20II\u53d7\u4f53\u963b\u6ede\u5242[ARB]\uff09\u6cbb\u7597\uff081B\uff09\u3002 \u63a8\u83503.6.2\uff1a\u5bf9\u4e8eCKD\u5408\u5e76\u767d\u86cb\u767d\u5c3f\u4e2d\u5ea6\u589e\u52a0\uff08G1-G4\u3001A2\uff09\u4e14\u65e0\u7cd6\u5c3f\u75c5\u7684\u60a3\u8005\uff0c\u63a8\u8350\u8d77\u59cbRASi\uff08ACEi\u6216ARB\uff09\u6cbb\u7597\uff082C\uff09\u3002 \u63a8\u83503.6.3\uff1a\u5bf9\u4e8eCKD\u5408\u5e76\u767d\u86cb\u767d\u5c3f\u4e2d\u81f3\u91cd\u5ea6\u589e\u52a0\uff08G1-G4\u3001A2\u548cA3\uff09\u4e14\u6709\u7cd6\u5c3f\u75c5\uff081B\uff09\u7684\u60a3\u8005\uff0c\u63a8\u8350\u8d77\u59cbRASi\uff08ACEi\u6216ARB\uff09\u6cbb\u7597\u3002 \u63a8\u83503.6.4\uff1aCKD\u60a3\u8005\u5e94\u907f\u514dACEi\u3001ARB\u548c\u76f4\u63a5\u80be\u7d20\u6291\u5236\u5242\uff08DRI\uff09\u8054\u5408\u4f7f\u7528\uff0c\u65e0\u8bba\u6709\u6216\u6ca1\u6709\u7cd6\u5c3f\u75c5\uff081B\uff09\u3002\u5b9e\u8df5\u8981\u70b93.6.1\uff1a\u5efa\u8bae\u4f7f\u7528RASi\uff08ACEi\u6216ARB\uff09\u5df2\u83b7\u6279\u7684\u6700\u9ad8\u8010\u53d7\u5242\u91cf\uff0c\u4ee5\u8fbe\u5230\u6cbb\u7597\u83b7\u76ca\u3002 \u5b9e\u8df5\u8981\u70b93.6.2\uff1a\u5728\u5f00\u59cbRASi\u6cbb\u7597\u6216\u589e\u52a0\u5242\u91cf\u540e\u76842~4\u5468\u5185\u76d1\u6d4b\u8840\u538b\u3001\u8840\u808c\u9150\u548c\u8840\u94be\u7684\u53d8\u5316\uff0c\u5177\u4f53\u53d6\u51b3\u4e8e\u5f53\u524d\u7684GFR\u548c\u8840\u94be\u6c34\u5e73\u3002 \u5b9e\u8df5\u8981\u70b93.6.3\uff1a\u4e0eRASi\u6cbb\u7597\u76f8\u5173\u7684\u9ad8\u94be\u8840\u75c7\u901a\u5e38\u53ef\u4ee5\u91c7\u53d6\u5176\u4ed6\u63aa\u65bd\u964d\u4f4e\u8840\u94be\u6c34\u5e73\uff0c\u800c\u4e0d\u662f\u51cf\u5c11RASi\u5242\u91cf\u6216\u505c\u7528RASi\u3002 \u5b9e\u8df5\u8981\u70b93.6.4\uff1a\u9664\u975e\u5728\u8d77\u59cbRASi\u6cbb\u7597\u6216\u589e\u52a0\u5242\u91cf\u540e\u76844\u5468\u5185\u8840\u808c\u9150\u6c34\u5e73\u5347\u9ad830%\u4ee5\u4e0a\uff0c\u5426\u5219\u7ee7\u7eedACEi\u6216ARB\u6cbb\u7597\u3002 \u5b9e\u8df5\u8981\u70b93.6.5\uff1a\u5728\u6709\u75c7\u72b6\u6027\u4f4e\u8840\u538b\u6216\u836f\u7269\u6cbb\u7597\u540e\u4ecd\u6709\u9ad8\u94be\u8840\u75c7\u6216\u6cbb\u7597\u80be\u529f\u80fd\u8870\u7aed\uff08\u4f30\u8ba1\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387[eGFR] <15 ml\/min\/1.73m2<\/sup>\uff09\u4ee5\u51cf\u5c11\u5c3f\u6bd2\u75c7\u75c7\u72b6\u7684\u60c5\u51b5\u4e0b\uff0c\u8003\u8651\u51cf\u5c11ACEi\u6216ARB\u5242\u91cf\u6216\u505c\u7528\u3002\u5b9e\u8df5\u8981\u70b93.6.6\uff1a\u5728\u7279\u6b8a\u60c5\u51b5\u4e0b\uff08\u5982\u6cbb\u7597\u9ad8\u8840\u538b\u6216\u5c04\u8840\u5206\u6570\u964d\u4f4e\u7684\u5fc3\u529b\u8870\u7aed\uff09\uff0c\u767d\u86cb\u767d\u5c3f\u6b63\u5e38\u6216\u8f7b\u5ea6\u589e\u52a0\uff08A1\uff09\u7684CKD\u60a3\u8005\u8003\u8651\u8d77\u59cbRASi\uff08ACEi\u6216ARB\uff09\u6cbb\u7597\u3002\u5b9e\u8df5\u8981\u70b93.6.7\uff1a\u5373\u4f7feGFR<30 ml\/min\/1.73m2<\/sup>\uff0cCKD\u60a3\u8005\u4ecd\u53ef\u7ee7\u7eedACEi\u6216ARB\u6cbb\u7597\u3002<\/p>\n

3.7\u94a0-\u8461\u8404\u7cd6\u5171\u8f6c\u8fd0\u86cb\u767d2\u6291\u5236\u5242\uff08SGLT2i\uff09 <\/p>\n

2024\u7248\u6307\u5357\u5de5\u4f5c\u7ec4\u540c\u610fKDIGO 2022\u6162\u6027\u80be\u810f\u75c5\u60a3\u8005\u7cd6\u5c3f\u75c5\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u4e2d\u63d0\u51fa\u7684\u201c\u63a8\u83502\u578b\u7cd6\u5c3f\u75c5\uff08T2D\uff09\u5408\u5e76CKD\u4e14eGFR\u226520 ml\/min\/1.73m2<\/sup>\u7684\u60a3\u8005\u4f7f\u7528SGLT2i\u6cbb\u7597\uff081A\uff09\u201d\u3002\u7136\u800c\uff0c\u65b0\u7248\u6307\u5357\u4e3aCKD\u6210\u4eba\u60a3\u8005\u63d0\u4f9b\u4e86\u4e00\u4e2a\u66f4\u5e7f\u6cdb\u76841A\u63a8\u8350\u3002<\/p>\n

\u63a8\u83503.7.1\uff1a\u63a8\u8350T2D\u5408\u5e76CKD\u4e14eGFR\u226520ml\/min\/1.73m2<\/sup>\u7684\u60a3\u8005\u4f7f\u7528SGLT2i\u6cbb\u7597 \uff081A\uff09\u3002 \u5b9e\u8df5\u8981\u70b93.7.1\uff1a\u4e00\u65e6\u542f\u52a8SGLT2i\u6cbb\u7597\uff0c\u5373\u4f7feGFR<20ml\/min\/1.73m2<\/sup>\uff0c\u4e5f\u53ef\u4ee5\u5408\u7406\u5730\u7ee7\u7eed\u4f7f\u7528\uff0c\u9664\u975e\u4e0d\u80fd\u8010\u53d7\u6216\u542f\u52a8\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\uff08KRT\uff09\u3002 \u5b9e\u8df5\u8981\u70b93.7.2\uff1a\u5728\u957f\u65f6\u95f4\u7981\u98df\u3001\u624b\u672f\u6216\u4e25\u91cd\u75be\u75c5\uff08\u5f53\u916e\u75c7\u9ad8\u98ce\u9669\u65f6\uff09\u65f6\uff0c\u505c\u7528SGLT2i\u3002 <\/p>\n

\u63a8\u83503.7.2\uff1a\u63a8\u8350SGLT2i\u6cbb\u7597\u5982\u4e0bCKD\u6210\u4eba\u60a3\u8005\uff081A\uff09\uff1a\uff08i\uff09eGFR\u226520 ml\/min\/1.73m2<\/sup>\u4e14\u5c3f\u767d\u86cb\u767d-\u808c\u9150\u6bd4\u503c\uff08ACR\uff09\u2265200 mg\/g\uff08\u226520 mg\/mmol\uff09\uff0c\u6216\uff08ii\uff09\u5fc3\u529b\u8870\u7aed\uff0c\u4e0e\u767d\u86cb\u767d\u5c3f\u6c34\u5e73\u65e0\u5173\u3002<\/p>\n

\u5b9e\u8df5\u8981\u70b93.7.3\uff1aSGLT2i\u6cbb\u7597\u65f6\u5e76\u4e0d\u9700\u8981\u6539\u53d8CKD\u7684\u76d1\u6d4b\u9891\u7387\uff0c\u8d77\u59cbSGLTi\u6cbb\u7597\u540e\u51fa\u73b0\u7684eGFR\u53ef\u9006\u6027\u4e0b\u964d\u901a\u5e38\u5e76\u4e0d\u662f\u505c\u6b62\u6cbb\u7597\u7684\u6307\u5f81\u3002 <\/p>\n

\u63a8\u83503.7.3\uff1a\u5efa\u8baeeGFR 20~45 ml\/min\/1.73m2<\/sup>\u4e14ACR<200 mg\/g\uff08<20 mg\/mmol\uff09\u7684\u6210\u4eba\u60a3\u8005\u4f7f\u7528SGLT2i\u6cbb\u7597 \uff082B\uff09\u3002<\/p>\n

3.8\u76d0\u76ae\u8d28\u6fc0\u7d20\u53d7\u4f53\u62ee\u6297\u5242\uff08MRA\uff09 <\/p>\n

2024\u7248\u6307\u5357\u5de5\u4f5c\u7ec4\u5f3a\u8c03\u4e86KDIGO 2022\u6162\u6027\u80be\u810f\u75c5\u60a3\u8005\u7cd6\u5c3f\u75c5\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u4e2d\u7684\u4e00\u4e2a\u5173\u952e\u63a8\u8350\u548c\u5b9e\u8df5\u8981\u70b9\u3002<\/p>\n

\u63a8\u83503.8.1\uff1a\u5bf9\u4e8eT2D\u3001eGFR>25 ml\/min\/1.73m2<\/sup>\u3001\u8840\u94be\u6b63\u5e38\u548c\u767d\u86cb\u767d\u5c3f\uff08>30 mg\/g[>3 mg\/mmol]\uff09\u7684\u60a3\u8005\uff0c\u5c3d\u7ba1\u5df2\u4f7f\u7528\u6700\u5927\u8010\u53d7\u5242\u91cf\u7684RASi\uff0c\u4ecd\u5efa\u8bae\u4f7f\u7528\u5df2\u88ab\u8bc1\u5b9e\u5177\u6709\u80be\u810f\u6216\u5fc3\u8840\u7ba1\u83b7\u76ca\u7684\u975e\u753e\u4f53\u7c7bMRA\uff082A\uff09\u3002\u5b9e\u8df5\u8981\u70b93.8.1\uff1a\u5bf9\u4e8e\u5176\u4ed6\u6807\u51c6\u6cbb\u7597\u540e\u4ecd\u5b58\u5728\u6301\u7eed\u6027\u767d\u86cb\u767d\u5c3f\u800cCKD\u8fdb\u5c55\u548c\u5fc3\u8840\u7ba1\u4e8b\u4ef6\u9ad8\u98ce\u9669\u7684T2D\u6210\u4eba\u60a3\u8005\uff0c\u975e\u753e\u4f53\u7c7bMRA\u662f\u6700\u4f73\u9009\u62e9\u3002\u5b9e\u8df5\u8981\u70b93.8.2\uff1a\u53ef\u4ee5\u5728RASi\u548cSGLT2i\u6cbb\u7597\u4e2d\u52a0\u5165\u4e00\u79cd\u975e\u753e\u4f53\u7c7bMRA\uff0c\u7528\u4e8e\u6cbb\u7597T2D\u5408\u5e76CKD\u60a3\u8005\u3002\u5b9e\u8df5\u8981\u70b93.8.3\uff1a\u4e3a\u4e86\u964d\u4f4e\u9ad8\u94be\u8840\u75c7\u7684\u98ce\u9669\uff0c\u5efa\u8bae\u9009\u62e9\u5728\u8840\u94be\u6d53\u5ea6\u6301\u7eed\u6b63\u5e38\u7684\u60a3\u8005\u4e2d\u4f7f\u7528\uff0c\u5e76\u5728\u5f00\u59cb\u4f7f\u7528\u975e\u753e\u4f53\u7c7bMRA\u540e\u5b9a\u671f\u76d1\u6d4b\u8840\u94be\uff08\u56fe2\uff09\u3002<\/p>\n

\u56fe2. \u975e\u753e\u4f53\u7c7b MRA\u6cbb\u7597\u671f\u95f4\u76d1\u6d4b\u8840\u94be\u5b9e\u8df5\u8981\u70b93.8.4\uff1a\u9009\u62e9\u975e\u753e\u4f53\u7c7bMRA\u6cbb\u7597\u65f6\u5e94\u4f18\u5148\u4f7f\u7528\u88ab\u8bc1\u5b9e\u6709\u80be\u810f\u6216\u5fc3\u8840\u7ba1\u83b7\u76ca\u7684\u836f\u7269\u3002 \u5b9e\u8df5\u8981\u70b93.8.5\uff1a\u753e\u4f53MRA\u53ef\u7528\u4e8e\u5fc3\u529b\u8870\u7aed\u3001\u919b\u56fa\u916e\u589e\u591a\u75c7\u6216\u96be\u6cbb\u6027\u9ad8\u8840\u538b\u7684\u6cbb\u7597\uff0c\u4f46\u53ef\u80fd\u5bfc\u81f4\u9ad8\u94be\u8840\u75c7\u6216\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\u53ef\u9006\u6027\u4e0b\u964d\uff0c\u7279\u522b\u662f\u5728GFR\u964d\u4f4e\u7684\u60a3\u8005\u4e2d\u3002 <\/p>\n

3.9\u80f0\u9ad8\u7cd6\u7d20\u6837\u80bd-1\u53d7\u4f53\u6fc0\u52a8\u5242\uff08GLP-1RA\uff09 <\/p>\n

2024\u7248\u6307\u5357\u5de5\u4f5c\u7ec4\u5f3a\u8c03\u4e86KDIGO 2022\u6162\u6027\u80be\u810f\u75c5\u60a3\u8005\u7cd6\u5c3f\u75c5\u7ba1\u7406\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u4e2d\u7684\u4e00\u4e2a\u5173\u952e\u63a8\u8350\u548c\u5b9e\u8df5\u8981\u70b9\u3002<\/p>\n

\u63a8\u83503.9.1\uff1a\u5bf9\u4e8e\u4f7f\u7528\u4e8c\u7532\u53cc\u80cd\u548cSGLT2i\u6cbb\u7597\u540e\u8840\u7cd6\u4e0d\u8fbe\u6807\u7684T2D\u5408\u5e76CKD\u6210\u4eba\u60a3\u8005\uff0c\u6216\u4e0d\u80fd\u4f7f\u7528\u8fd9\u4e9b\u836f\u7269\u7684\u60a3\u8005\uff0c\u63a8\u8350\u4f7f\u7528\u957f\u6548GLP-1 RA\u6cbb\u7597\uff081B\uff09\u3002 <\/p>\n

\u5b9e\u8df5\u8981\u70b93.9.1\uff1a\u4f18\u5148\u9009\u62e9\u5177\u6709\u5fc3\u8840\u7ba1\u83b7\u76ca\u8bc1\u636e\u7684GLP-1RA\u3002 <\/p>\n

\uff08\u6765\u6e90\uff1a\u300a\u80be\u533b\u7ebf\u300b\u7f16\u8f91\u90e8\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

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