佳临床实践关于糖尿病合并慢性肾脏病3b期或更高阶段临床管理指南_精品文档PPT资料.ppt

佳临床实践关于糖尿病合并慢性肾脏病3b期或更高阶段临床管理指南_精品文档PPT资料.ppt

《佳临床实践关于糖尿病合并慢性肾脏病3b期或更高阶段临床管理指南_精品文档PPT资料.ppt》由会员分享，可在线阅读，更多相关《佳临床实践关于糖尿病合并慢性肾脏病3b期或更高阶段临床管理指南_精品文档PPT资料.ppt（40页珍藏版）》请在冰豆网上搜索。

ChengJiClinicalPracticeGuidelineonmanagementofpatientswithdiabetesandchronickidneydiseasestage3borhigher（eGFR45mL/min）1112PURPOSEANDSCOPEOFTHISGUIDELINE3Whywasthisguidelineproduced?

@#@lThisclinicalpracticeguidelinewasdesignedtofacilitateinformeddecision-makingonthemanagementofadultindividualswithdiabetesmellitusandCKDstage3borhigher（eGFR45mL/min）.lItwasnotintendedtodefineastandardofcare,andshouldnotbeconstruedassuch.Itshouldnotbeinterpretedasaprescriptionforanexclusivecourseofmanagement.4Whoisthisguidelinefor?

@#@ThisguidelineintendstosupportclinicaldecisionmakingbyanyhealthcareprofessionalcaringforpatientswithdiabetesandCKDstage3borhigher（eGFR45mL/min）,i.e.forgeneralpractitioners,internists,surgeonsandotherphysiciansdealingwiththisspecificpatientpopulationinbothanoutpatientandanin-hospitalsetting.Theguidelinealsoaimstoinformaboutthedevelopmentofstandardsofcarebypolicy-makers.5CHAPTER1:

@#@ISSUESRELATEDTORENALREPLACEMENTMODALITYSELECTIONINPATIENTSWITHDIABETESANDEND-STAGERENALDISEASE6ShouldpatientswithdiabetesandCKDstage5startwithperitonealdialysisorhaemodialysisasafirstmodality?

@#@Statements1.1.1WerecommendgivingprioritytothepatientsgeneralstatusandpreferenceinselectingrenalreplacementtherapyasthereisanabsenceofevidenceofsuperiorityofonemodalityoveranotherinpatientswithdiabetesandCKDstage5（1C）.1.1.2Werecommendprovidingpatientswithunbiasedinformationaboutthedifferentavailabletreatmentoptions（1A）.1.1.3Inpatientsoptingtostarthaemodialysis（HD）,wesuggestpreferinghighfluxoverlowfluxwhenthisisavailable（2C）.1.1.4WesuggestdiabeteshasnoinfluenceonthechoicebetweenHDorhaemodiafiltration（HDF）（2B）.7ShouldpatientswithdiabetesandCKDstage5startdialysisearlier,i.e.beforebecomingsymptomatic,thanpatientswithoutdiabetes?

@#@Statements1.1.1Werecommendinitiatingdialysisinpatientswithdiabetesonthesamecriteriaasinpatientswithoutdiabetes（1A）.1.TattersallJ,DekkerF,HeimburgerO,etalWhentostartdialysis：

@#@updatedguidancefollowingpublicationoftheInitiatingDialysisEarlyandLate（IDEAL）studyJ.NephrolDialTransplant,2011,26:

@#@2082-2086.8InpatientswithdiabetesandCKDstage5,shouldanativefistula,graftortunnelledcatheterbepreferredasinitialaccess?

@#@Statements1.3.1WerecommendthatreasonableeffortbemadetoavoidtunnelledcathetersasprimaryaccessinpatientswithdiabetesstartingHDasrenalreplacementtherapy（1C）.1.3.2Werecommendthattheadvantages,disadvantagesandrisksofeachtypeofaccessbediscussedwiththepatient.910IsthereabenefittoundergoingrenaltransplantationforpatientswithdiabetesandCKDstage5?

@#@1.4.1WerecommendprovidingeducationonthedifferentoptionsoftransplantationandtheirexpectedoutcomesforpatientswithdiabetesandCKDstage4or5whoaredeemedsuitablefortransplantation（Table5）（1D）.11IsthereabenefittoundergoingrenaltransplantationforpatientswithdiabetesandCKDstage5?

@#@Statementsonlyforpatientswithtype1diabetesandCKDstage51.4.2Wesuggestlivingdonationkidneytransplantationorsimultaneouspancreaskidneytransplantationtoimprovesurvivalofsuitablepatients（2C）.1.4.3Wesuggestagainstislettransplantationafterkidneytransplantationwiththeaimtoimprovesurvival（2C）.1.4.4Wesuggestpancreasgraftingtoimprovesurvivalafterkidneytransplantation（2C）.12IsthereabenefittoundergoingrenaltransplantationforpatientswithdiabetesandCKDstage5?

@#@Statementsonlyforpatientswithtype2diabetesandCKDstage51.4.5Werecommendagainstpancreasorsimultaneouskidneypancreastransplantation（1D）.1.4.6Werecommenddiabetesinitselfshouldnotbeconsideredacontraindicationtokidneytransplantationinpatientswhootherwisecomplywithinclusionandexclusioncriteriafortransplantation（1C）.13CHAPTER2.ISSUESRELATEDTOGLYCAEMICCONTROLINPATIENTSWITHDIABETESANDCKDSTAGE3BORHIGHER（eGFR45mL/min）14A.ShouldweaimtolowerHbA1CbytighterglycaemiccontrolinpatientswithdiabetesandCKDstage3borhigher（eGFR45mL/min）?

@#@B.Isanaggressivetreatmentstrategy（innumberofinjectionsandcontrolsandfollow-up）superiortoamorerelaxedtreatmentstrategyinpatientswithdiabetesandCKDstage3borhigher（eGFR8.5%（1C）.2.1.3WesuggestvigilantattemptstotightenglycaemiccontrolwiththeintentiontolowerHbA1CaccordingtotheflowchartinFigure4inallotherconditions（2D）.2.1.4Werecommendintenseself-monitoringonlytoavoidhypoglycaemiainpatientsathighriskforhypoglycaemia（2D）.中国成人2型糖尿病HbA1C控制目标的专家共识建议对T2DM合并CKD患者的HbA1C可适当放宽控制在79。

@#@161718AretherebetteralternativesthanHbA1ctoestimateglycaemiccontrolinpatientswithdiabetesandCKDstage3borhigher（eGFR45mL/min/1.73m2）?

@#@Statements2.2.1WerecommendtheuseofHbA1CasaroutinereferencetoassesslongertermglycaemiccontrolinpatientswithCKDstage3borhigher（eGFR45mL/min/1.73m2）（1C）.在晚期CKD患者，使用糖化血清蛋白反映血糖控制水平可能更可靠。

@#@2型糖尿病合并慢性肾脏病患者口服降糖药用药原则中国专家共识19A.Isanyoraldrugsuperiortoanotherintermsofmortality/complications/glycae