肾性贫血治疗指南.pptx

肾性贫血治疗指南
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CPR . IDENTIFYING PATIENTS AND INITIATING EVALUATION
贫血的检查流程
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CPG AND CPR . HB RANGE
Lower limit of Hb: In patients with CKD, Hb should be g/dL or greater. (MODERATELY STRONG RECOMMENDATION)
Upper limit of Hb: In the opinion of the Work Group, there is insufficient evidence to recommend routinely maintaining Hb levels at g/dL or greater in ESA-treated patients.
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HEMOGLOBIN TARGET 2007
In the opinion of the Work Group, selection of the Hb target and selection of the Hb level at which ESA therapy is initiated in the individual patient should include consideration of potential benefits (including improvement in quality of life and avoidance of transfusion) and potential harms (including the risk of life threatening adverse events). (Clinical Practice RECOMMENDATION)
In the opinion of the Work Group, in dialysis and nondialysis patients with CKD receiving ESA therapy, the selected Hb target should generally be in the range of to g/dL. (Clinical Practice RECOMMENDATION)
In dialysis and nondialysis patients with CKD receiving ESA therapy, the Hb target should not be greater than g/dL. (Clinical Practice GUIDELINE – MODERATELY STRONG EVIDENCE)
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rHuEPO 治疗肾性贫血靶目标值
Hb 110～120 g/L (Hct 33~36%)，建议Hb不超过130 g/L。
靶目标值应在开始治疗后4 个月内达到，并依据患者年龄、种族、性别、生理需求以及是否合并其他疾病进行个体化调整：
伴有缺血性心脏病、充血性心力衰竭等心血管疾病的患者不推荐Hb>120 g/L；
糖尿病的患者，特别是并发外周血管病变的患者，需在监测下谨慎增加Hb 水平至120；
合并慢性缺氧性肺疾病患者推荐维持较高的Hb 水平。
注：Hb治疗目标值上限, 在2007年K/DOQI补充材料发表前一直不明朗。于2006年K/DOQI修订版发布后一年间，又有5个研究Hb靶目标值的大型临床随机对照试验完成，治疗观察例数增加了一倍，在此基础上进行荟萃分析即清晰发现，Hb目标值 ＞130g/L 时发生威胁生命的不良事件风险会显著增加，如此才获得了上述结论。
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CPR . USING ESAs
Frequency of Hb monitoring:
In the opinion of the Work Group, the frequency of Hb monitoring in patients treated with ESAs should be at least monthly.
In the opinion of the Work Group, the initial ESA dose and ESA dose