CKD Thai Guideline 2009

8/3/2019 CKD Thai Guideline 2009

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ISBN 974-300-791-0

1 2552 5,000

2 50 3 47 10310 0-2716-6901

()


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(Chronic Kidney Disease, CKD)

(End Stage Renal Disease,

ESRD)

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III


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IV


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7 .. 2552 8 9

11 12

13 14

1: 15 2: 17 3: 20 4: 21

5: 22 6: 24 7: 25

V


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8: 28 9: 29 10: 30 11: 34

12: 35

13: 36 14: 37 15: 38 16: 39 17: 40

1 43 2 44

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3 (eGFR) 45 MDRD 4 (eGFR) 46

MDRD

IV


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7


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a (cost effective)

+

c

b

Strength of Recommendation


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Quality of Evidence1

1.1 (systematic review)- (randomize-controlled clinical trial) 1

1.2 -(a well-designed randomize-controlled clinical

trial) 1

2 2.1

(non-randomized controlled clinicaltrial)

2.2 (well-designed non-randomized controlled

clinical trial) 2.3

(cohort) (case-control analytical studies) /


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2.4 (multiple time series) .. 2480

3 3.1 (descriptive studies) 3.2

(fair-designed controlled clinical trial)

4 4.1

(consensus)

4.2 (case series)

2 (anecdotal report)


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1. (screening and consultationor referral)

2. (slowing the progression of kidney

disease)

3. (evaluationand treating CKD complications)

4. (cardiovascu-lar risk reduction)

5. (preparation for renalreplacement therapy)


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1. 3 (glomerular filtration rate, GFR)

1.1 2 3 1.1.1

1.1.1.1 microalbuminuria

1.1.1.2 proteinuria 500 mg 500 mg/g creatinine

1.1.2 (hematuria)1.2 1.3

2. GFR 60 mL/min/1.73m2 3


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1 GFR 902 GFR 60 - 893 GFR 30 - 594 GFR 15 - 295 < 15 (

)

GFR (mL/min/1.73m2)


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: 2.2 ( 18)

micro proteinuria

albuminuria

total 24 < 300 mg - > 300 mgprotein

- (dipstick) < 200 mg/g - > 200 mg/g

creatinine creatinine protein/

creatinine ratio

albumin 24 < 30 mg 30-300 mg > 300 mg -

(microalbuminuria

dipstick)

< 30 mg/g 30-300 > 300 mg/g creatinine mg/g creatinine

albumin/ creatininecreatinine ratio


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1

1.1 ( a 1)

1.2 ( a 2)

1.3 (autoimmune diseases)

( + 3)

1.4 (systemic infection) ( + 3)

1.5 (cardiovascular disease) ( + 3)

1.6 ( + 3)


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1.7 ( + 4)

1.8 60 ( + 4)

1.9 ( + 4)

1.10 ( + 4)

1.11 ( + 4)


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2

1 2.1 estimated GFR (eGFR) 1 (serum creatinine, SCr) Modification of Diet in Renal Disease (MDRD)

Equation[1] ( a 2)

eGFR (mL/min/1.73m2) =

186.3 x SCr (jaffe) 1.154 x Age 0.203 x (0.742 )

MDRD equation eGFR Crockcoft-Gault equation ( c 4)

[2] 1.73m2

CCr (ml/min) =(140Age) x Body weight

x (0.85 )72 x SCr

[1] racial-factor eGFR racial-factor 1.016

MDRD

[2] Body surface area (Mosteller formula) = Body weight (kg) x Hight (cm)3,600


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2.2 (Dipstick)

2.2.1 2.2.1.1 1+

( a3)

2.2.1.2 urinary albumin/creatinine ratio

(UACR) (spotmorning urine) 30-300 mg/g

microalbuminuria ( a2)

2.2.1.3 UACR microalbuminuria dipstick

microalbuminuria

( +4)

2.2.2 2.2.2.1 2+


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2.2.2.2 1+ urinary protein/creatinine ratio(UPCR) 500 mg/g

( a3)

2.3 microscopic examination

5/HPF ( a 4)

2.4 2.1 - 2.3 3 ( a 4)

2.5 (plain KUB) / (ultrasonography of KUB) ( c 4)


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3

eGFR ( a 4)

3.1 1 2 12

( 6 )

3.2 3 6 ( 12

)

3.3 4 3 ( 6 )

3.4 5 3


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4

4.1 4.1.1 eGFR 30-59 mL/min/1.73m2

7 mL/min/1.73m2 ( a 4)

4.2 4.2.1 eGFR 30-59 mL/min/1.73m2

7 mL/min/1.73m2 ( a 4)

4.2.2 eGFR 30 mL/min/1.73m2

( a 4)

4.2.3 1,000 mg spot urine protein/creatinine ratio 1,000mg/g creatinine

( c 4)


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5

5.1 130/80 mmHg ( a 1)

5.2 angiotensin

converting enzyme inhibitor (ACEI) angiotensin recep-tor blocker (ARB)

( a 1)

5.3 ACEI ARB ( a 1)

5.4 ACEI ARB (SCr) (serum K) [3]

SCr 30% 4 serum K5.5 mmol/L

( a 3)


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5.5 2

( a 2)

[3] , GFR ACEI ARB

(.) 120 110 - 119 < 110GFR (mL/min/1.73m2) 60 30 - 59 < 30

GFR (%) < 15 15 - 30 > 30 (mmol/L) 4.5 4.6 - 5.0 > 5

4-12 2-4 < 2 BP 6-12 3-6 1-3


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7

7.1

7.1.1 (Preprandial capillary plasmaglucose) 90-130 mg/dL (5.0-7.2 mmol/L)

( + 2)

7.1.2 (Peak postprandial capil-lary plasma glucose) 180 mg/dL (


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7.2.2 7.2.2.1 biguanide (metformin) :

serum creatinine 1.5 mg/dL 1.4 mg/dL ( 4)

7.2.2.2 sulfonylurea chlorpropamide :

( 2)

glybenclamide : eGFR 30 mL/min/1.73m2

( 4)

glipizide gliclazide : eGFR 10 mL/

min/1.73m2

( + 3)

7.2.2.3 alpha-glucosidase inhibitors :

acarbose miglitol eGFR 30 mL/min/1.73m2

( 4)


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7.2.2.4 metiglinide (repaglinide) : ( +4)

nateglinide eGFR 30 mL/min/

1.73m2

( 4)

7.2.2.5 thiazolidinedione : ( +2)

Rosiglitazone ( 2)

7.2.3 ( a 2)


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8

8.1 LDL cholesterol 100 mg/dL ( a 3)

70 mg/dL

( c 3)

8.2 statin ( a 2)

8.3 statin ( + 2)


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9

( a 1)


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10

10.1

10.1.1 eGFR 30 mL/min/1.73m2 ( 4-5) 0.6 / [4]

( + 2)

10.1.2 eGFR 30 mL/min/1.73m2 ( 1-3) 0.6-0.8 / ( + 2)

10.1.3 (highbiological value protein)

60 ( a 2)

10.2 10.2.1 60 35 /

/ ( a 3)

[4] () = () 100 = () 110


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10.2.2 60 30-35 / / ( a 3)

10.3 ACEI [5]

( a 3)

[5]

(100-200 / 1 ) (250-350 / 1 )


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10.4 100

(2,300 ) ( a 3)

10.5 (body mass index, BMI)

( a 4)

10.6 (serum albumin) 3-6 3.5 g/dL ( a 1)

10.7 (Dietary protein intake) 3-6 normalized protein catabolic rate

(nPNA) [6]

[6] UNA = UUN (g N/day) + NUN (g N/day)

NUN = 0.031 g N x body weight in Kg

PNA = UNA x 6.25

[UNA = urea nitrogen appearance, UUN = 24-hour urinary urea nitrogen (g N/day),

N = nitrogen, NUN = non urea nitrogen (g N/day), PNA = protein equivalent of total

nitrogen appearance (g protein/day)]


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nPNA dietary recall food record ( + 4)

10.8 24 3-6 ( c 3)


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11

11.1 serum calcium (Ca) phosphate (P)

( a 2)

11.1.1 corrected serum Ca 9.0-10.2 mg/dL

11.1.2 serum P 2.7-4.6 mg/dL11.1.3 serum Ca x P 55 (mg/dL)2

11.2 serum P (phosphate binder) ( a 2)

11.3 ( + 2)

11.4 5 (Hyperparathyroidism) (intact parathyroid hormone, iPTH) iPTH 150-300 pg/mL ( + 1)


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12

12.1 Hemoglobin (Hb) 10.0 g/dL

erythropoiesis stimulating agent (ESA)

( + 2/3)

12.2 ESA Hb 10.0 g/dL serum ferritin 100 ng/mL Transferrin saturation (TSAT) 20% ESA 3 ( a 2)

serum fer-ritin 500 ng/mL

( a 2)

12.3 ESA Hb 10.0g/dL

( a 3)

13.0 g/dL ( a 1)


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13

- ( 22 mmol/L) ( a 3)


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non steroidal anti-inflammatory drugs (NSAIDs) COX2 inhibitors aminoglycosides radiocontrast agents ( b 4)


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15

15.1

(hepatitis B vaccine)

2 3 (0, 1, 6 )

deltoid 1 (anti

HBs


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16

16.1 (very high risk) ( a 1)

16.2 ( a 3)

16.2.1 (Chest x-ray)16.2.2 (EKG)

16.3 ( a 3)

16.4 ( a 3)


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17

17.1 4 (eGFR < 30 mL/min/

1.73m2)

( + 4)

17.2 4 ( a 4)

17.3 (vascular access) 4 arterio-venous

fistula ( + 3)


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42 ()


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43


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1 1-4

.. . . . . . ..

3 7-9

. . .. .. ..

.

5 12-14

. .

.

.

.. .. .. . .

2 5-6 .. . ... . . .. .

4 10-11

.. .. . ... .

.

. . .

6 15-17

.

.

.

.. . ..


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3 (eGFR) MDRD( mL/min/1.73m2)

() (mg/dL) 20 30 40 50 60 70 80

0.8 >90 >90 >90 >90 >90 >90 >90

0.9 >90 >90 >90 > 90 >90 89 86

1.0 >90 >90 88 84 81 79 76

1.1 >90 84 79 75 73 70 68

1.2 82 76 71 68 66 64 62

1.3 75 69 65 62 60 58 56

1.4 69 63 60 57 55 53 52

1.5 63 58 55 53 51 49 48

1.6 59 54 51 49 47 46 44

1.7 55 51 48 46 44 43 41

1.8 51 47 45 43 41 40 391.9 48 44 42 40 39 37 36

2.0 46 42 40 38 36 35 34

2.1 43 40 37 36 34 33 32

2.2 41 38 35 34 33 32 31

2.3 39 36 34 32 31 30 29

2.4 37 34 32 31 29 29 28

2.5 35 32 31 29 28 27 27

2.6 34 31 29 28 27 26 25

2.7 32 30 28 27 26 25 24

2.8 31 28 27 26 25 24 23

2.9 30 27 26 25 24 23 22

3.0 28 26 25 24 23 22 22

3.1 27 25 24 23 22 21 21

3.2 26 24 23 22 21 21 203.3 26 24 22 21 20 20 19

3.4 25 23 21 20 20 19 19

3.5 24 22 21 20 19 18 18

3.6 23 21 20 19 18 18 17

3.7 22 21 19 19 18 17 17

3.8 22 20 19 18 17 17 16

3.9 21 19 18 17 17 16 16

4.0 20 19 18 17 16 16 15

4.1 20 18 17 16 16 15 15

4.2 19 18 17 16 15 15 15

4.3 19 17 16 16 15 15 14

4.4 18 17 16 15 15 14 14

4.5 18 16 16 15 14 14 13

4.6 17 16 15 14 14 13 13

4.7 17 16 15 14 14 13 13

4.8 17 15 14 14 13 13 13

4.9 16 15 14 13 13 13 12

5.0 16 15 14 13 13 12 12

5.1 15 14 13 13 12 12 12

5.2 15 14 13 13 12 12 11

5.3 15 14 13 12 12 11 11

5.4 14 13 12 12 11 11 11

5.5 14 13 12 12 11 11 11

5.6 14 13 12 12 11 11 10


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CKD Thai Guideline 2009

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Transcript of CKD Thai Guideline 2009