肾性贫血治疗指南.ppt

肾性贫血治疗指南肾性贫血治疗指南 1 12 23 3 CPR . CPR . IDENTIFYING PATIENTS IDENTIFYING PATIENTS AND INITIATING EVALUATION AND INITIATING EVALUATION Stage and cause of CKD: In the opinion of the Stage and cause of CKD: In the opinion of the Work Group, Hb testing should be carried out Work Group, Hb testing should be carried out in all in all patients with CKD patients with CKD , regardless of stage or cause. , regardless of stage or cause. Frequency of testing for anemia: In the opinion of Frequency of testing for anemia: In the opinion of the Work Group, Hb levels should be measured at least the Work Group, Hb levels should be measured at least annually annually . . Diagnosis of anemia: In the opinion of the Work Diagnosis of anemia: In the opinion of the Work Group, diagnosis of anemia should be made and further Group, diagnosis of anemia should be made and further evaluation should be undertaken at the following Hb evaluation should be undertaken at the following Hb concentrations: concentrations: ●● < g/dL in adult males. < g/dL in adult males. ( ( g/dL g/dL ) ) ●●< g/dL in adult females. < g/dL in adult females. ( ( g/dL g/dL ) ) 4 4贫血定义贫血定义 WHO WHO 的贫血诊断标准: 的贫血诊断标准: ***女性血红蛋白( ***女性血红蛋白( Hb Hb ) ) < 120 g/L < 120 g/L ***男性***男性 Hb < 130 g/L Hb < 130 g/L 但应考虑患者年龄、种族、居住地的海拔高度和生理需求对但应考虑患者年龄、种族、居住地的海拔高度和生理需求对 Hb Hb 的影响。的影响。注:肾性贫血主要为促红细胞生成素不足导致,只有如下各条内容均具备才能下临床诊断: ①患者患有慢性肾脏病(CKD ),并已有肾功能损害; ② H b 已达到上述贫血诊断标准; ③能够除外 C K D 以外因素所致贫血。注: 2004 年 EBPG 及 2006 年 K/DOQI 均明确指出,在评估贫血时, 检测 H b 浓度比检测 H c t 更容易、更稳定、更可靠,所以近年肾性贫血诊疗指南都再不用 Hct 诊断贫血。血液透析患者血标本应在血透开始前或刚开始血透时即刻采集。 5 5 CPR CPR 1 1. .2 2. . EVALUATION OF EVALUATION OF ANEMIA IN CKD ANEMIA IN CKD In the opinion of the Work Group, initial assessment of anemia In the opinion of the Work Group, initial assessment of anemia should include the following tests: should include the following tests: plete blood cou