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中华肾病研究电子杂志 ›› 2020, Vol. 09 ›› Issue (01) : 22 -28. doi: 10.3877/cma.j.issn.2095-3216.2020.01.005

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KDIGO关于血液净化争议研讨会相关议题的解读与思考
刘文敏1, 王保兴1,()   
  1. 1. 050001 河北医科大学第三医院肾内科
  • 收稿日期:2019-11-18 出版日期:2020-02-28
  • 通信作者: 王保兴

Interpretation and consideration of related issues at the KDIGO controversies conference on blood purification

Wenmin Liu1, Baoxing Wang1,()   

  1. 1. Department of Nephrology, Third Hospital of Hebei Medical University, Shijiazhuang 050001, Hebei Province, China
  • Received:2019-11-18 Published:2020-02-28
  • Corresponding author: Baoxing Wang
  • About author:
    Corresponding author: Wang Baoxing, Email:
引用本文:

刘文敏, 王保兴. KDIGO关于血液净化争议研讨会相关议题的解读与思考[J]. 中华肾病研究电子杂志, 2020, 09(01): 22-28.

Wenmin Liu, Baoxing Wang. Interpretation and consideration of related issues at the KDIGO controversies conference on blood purification[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2020, 09(01): 22-28.

血液净化是终末期肾脏病(ESRD)的主要治疗方法,主要通过除去血液中某些致病物质,净化血液,达到治疗疾病的目的。改善全球肾脏病预后组织(Kidney Disease: Improving Global Outcomes, KDIGO)2018年研讨会指出:应根据ESRD患者的意愿、医疗政策、医疗基础设施等确定最适合患者的透析治疗方法,提供个性化的治疗服务。在临床实践中要根据风险方程式确定透析开始时机、及时对患者进行转诊,使患者能够提前准备透析通路,从而为患者提供更高质量的目标导向透析治疗,达到及时改善症状、提高生活质量之目的。本文就本次研讨会的主要内容如透析开始时机、透析方式选择、透析通路和透析处方等有关议题进行了解读。

Blood purification is the main treatment method for end-stage renal disease (ESRD). It mainly purifies the blood by removing certain pathogenic substances from the blood to achieve the purpose of treating the disease. The KDIGO controversies conference on blood purification in 2018 pointed out that the most suitable dialysis treatment method should be determined according to the preferences of ESRD patients, medical policies, and medical infrastructure, etc, so as to provide personalized treatment services. In clinical practice, it is necessary to determine the starting time of dialysis according to the risk equation and refer patients in time, so that the patients can be prepared for dialysis access in advance, and provided with higher-quality goal-oriented dialysis treatment to achieve the purpose of timely improvement of symptoms and quality of life. This article explained the main contents of this conference, such as the starting timing of dialysis, the choice of dialysis modes, the dialysis access, as well as the dialysis prescription.

表1 患者和医保系统对透析认识存在的问题和可能的解决方案
表2 预测需要肾脏替代治疗时机的风险方程
表3 透析方式和开始时间:研究需求和建议
? 调查的关键问题和方法
透析导入时间是否开始透析 1.是否可以使用CKD衰弱指数来指导患者治疗决策?该指数由什么构成?可以在IPOS肾脏指数的基础上吗?
2.CKD衰弱指数是否可以与传统和新的生物标记物和临床评分系统(液体状态、营养状态和/或身体成分的系列评估)相结合来指导透析的开始?
3.透析开始后尿毒症症状发生多大程度的变化?
4.是否可以使用CKD脆弱指数来识别个体在透析前和开始透析后随时间在临床上的重要变化?
5.HD和PD的变化是否不同?
6.是否可以预测哪些患者病情好转而哪些病情恶化?
什么时间开始 1.通过积极的医疗管理,可以安全地推迟透析的开始时间吗?
2.当肾脏疾病患者从CKD G5过渡到G5D时,综合护理模式是否可以提高质量并降低肾病患者的费用?
转诊时间和计划外的开始 1.如何减少计划外的开始次数?
2.如何改善晚期CKD患者的转诊和最佳治疗?
3.如何确定急性肾损伤或心力衰竭加重的高风险的CKD患者?
4.ACE抑制剂,二甲双胍和NSAID可以预防病情加重吗?
5.急性肾损伤患者的结局如何改善?
6.哪些措施可以促进急性肾损伤患者的肾脏恢复?
7.CKD G5至G5D与患有急性肾损伤的CKD的透析方法是否应有所不同?
8.在高危人群中进行CKD普查的现实效果和成本效益是什么?
9.公共卫生监测系统(公共卫生实验室和提供者)进行CKD筛查和风险预测有效性如何?
10.过渡期的多学科护理能否改善患者的生存率,住院率,成本效益和生活质量等结果?
11.对于转诊较晚的选择PD的患者,以PD开始的患者与短时期HD开始的患者相比的结局如何?
12.大规模研究评估了紧急开始PD与短期和长期HD的结局如何?
模式的选择 1.指导患者透析方式的最佳时机是什么?最佳时间是否根据患者特征而变化?
2.针对每种治疗方式的优缺点,对患者进行教育的最佳内容和形式是什么?如何评估他们是否理解?
3.各亚组患者(如儿童、孕妇)的各种透析方式的结果如何?
4.在开始透析的前90 d内,"意外"死亡的特征和共性是什么,尤其是那些基础病少的患者?
5.性别平等建立的障碍是什么?这些障碍因国家而有何不同?
6.临时护理在保留家庭透析患者方面有效吗?
7.与接受常规透析的家庭护理相比,远程医疗和/或远程监控对增加治疗时间和减少并发症的功效如何?
透析处方 1.进行递增透析时肾功能或相关症状的评估标准是什么?
2.通过随机对照试验评估,递增透析与常规全剂量启动的透析(HD或PD)相比,残余肾功能和患者报告等结局指标如何?
监测 1.远程医疗和/或远程监控与家庭透析的传统护理相比如何?
表4 避免延迟转诊至专科肾脏病治疗的策略
表5 ESRD患者透析通路的选择方案及综合规划
表6 实施目标导向透析的要求
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