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FIM =HF=............................................................................................................................................................... 12
@ 2 FIM =HF= ! (IF H=G F MF, M ! AC HFM) F
@ K=H, F H F=G , CD .................................................................................................................................................... 13
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3.1 @-H...................................................................................................................................................................... 39
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http://kdigo.org/home/guidelines/ckd-evaluation-management/http://kdigo.org/home/guidelines/ckd-evaluation-management/http://www.renalreg.com/Reports/2013.htmlhttp://www.renalreg.com/Reports/2013.htmlhttp://www.renalreg.com/Reports/2013.htmlhttp://www.renalreg.com/Reports/2013.htmlhttp://kdigo.org/home/guidelines/ckd-evaluation-management/http://kdigo.org/home/guidelines/ckd-evaluation-management/7/25/2019 CG182 NICE Guidance 20150309
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FHFM F CD.
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H=H-HF FH=H-HF F
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M F=F=H=G F =@HH=M F=F=H=G F =@HH=
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=M =GG. K 2014K 2014
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F HGH= F CD IG= !FH== AC H @ K=H M H @@K= F=G
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http://www.nice.org.uk/guidance/cg182/chapter/recommendationshttp://www.nice.org.uk/guidance/cg182/chapter/recommendations#terms-used-in-this-guidelinehttp://www.nice.org.uk/guidance/cg182/chapter/recommendations#terms-used-in-this-guidelinehttp://www.nice.org.uk/guidance/cg182/chapter/recommendations#terms-used-in-this-guidelinehttp://www.nice.org.uk/guidance/cg182/chapter/recommendations#acute-kidney-injury-and-ckdhttp://www.nice.org.uk/guidance/cg182/chapter/recommendations#acute-kidney-injury-and-ckdhttp://www.nice.org.uk/guidance/cg182/chapter/recommendations#terms-used-in-this-guidelinehttp://www.nice.org.uk/guidance/cg182/chapter/recommendations#terms-used-in-this-guidelinehttp://www.nice.org.uk/guidance/cg182/chapter/recommendations#terms-used-in-this-guidelinehttp://www.nice.org.uk/guidance/cg182/chapter/recommendations7/25/2019 CG182 NICE Guidance 20150309
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F=JGI@F =GG (=G= FH =GG, F= FH =@IF, F=F@
JGI@F =GG F FF@ JGI@F =GG)
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T!"% 1 C!:#!/ /& #/# +$%8 $%!% ' GFR !$ ACR #!%'/%
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F%%#8 /& //'
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T!"% 2 F%%#8 /& //' /& GFR ("% /& % 0% 8%!, "8 GFR !$
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=HF @ F H J@H F FFGG= CD F H @GH 2R3 MFG HF IH=M =IFM, J = GFI FH== G FHIF H G@=. K 2014K 2014
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Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
, NICE 2014. A"" &gh' &e'e&*ed. La' #%d-ed Ja$a&+ 2015 Page 15 %f 62
http://www.nice.org.uk/Guidance/CG182/Evidence/http://www.nice.org.uk/guidance/CG182/chapter/About-this-guidelinehttp://www.nice.org.uk/guidance/cg182/chapter/key-priorities-for-implementation#table-1-classification-of-chronic-kidney-disease-using-gfr-and-acr-categorieshttp://www.nice.org.uk/guidance/cg182/chapter/key-priorities-for-implementation#table-1-classification-of-chronic-kidney-disease-using-gfr-and-acr-categorieshttp://www.nice.org.uk/guidance/cg182/chapter/key-priorities-for-implementation#table-1-classification-of-chronic-kidney-disease-using-gfr-and-acr-categorieshttp://www.nice.org.uk/guidance/cg182/chapter/key-priorities-for-implementation#table-1-classification-of-chronic-kidney-disease-using-gfr-and-acr-categorieshttp://www.nice.org.uk/guidance/CG182/chapter/About-this-guidelinehttp://www.nice.org.uk/Guidance/CG182/Evidence/7/25/2019 CG182 NICE Guidance 20150309
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FFFG =FG =M =GGM =GG
G =@I @I=IF= (AC F H 3 /@), IF= G=H F@=H=G, @HF@MH
HF F@=H=G I H HII@F =GFFG, F@=H=G HH M =GH@M, GHFIHIF@
F@=H=G HH M ==, =GHFM =M HFG@HH=.
=R=HG=R@GHF GMGH H=GH=R=HG=R@GHF GMGH H=GH
A FI HH @G F ===HG H F=R=HG=R@GHF GMGH =@I= =HG=-
JFH= NM (ACE) ===HFG, =HG=-FHF @FG (ABG), =FH F= ===HFG
@GHF H=GHG.
=R=HG= GMGH H=GH=R=HG= GMGH H=GH
A FI HH @G F ===HG H F=R=HG= GMGH =@I= ACE ===HFG, ABG
=FH F= ===HFG. =G FI FIG G H =@I @GHF H=GHG.
1.1 I%'!/ &/ #/# +$%8 $%!%
GIF= =GIF= =M IH=M IH=
CC%!%-"!%$ %!% /& GFR%!%-"!%$ %!% /& GFR
1.1.1 JF FIGH F GFI FH== GIFH =G , @==@
@FHF=G GI@ FFH GH=H @FI@F T@HFH= FH
(!FH==) IG= F=H= IH= (G FH= 1.1.2) =
=H= H FFH= H GFI FH== FGI@H2
. 20142014
1.1.2 C@==@ @FHF=G GI@:
IG H CF= =M D=GG E==@M C@@FH= (CD-E#) FH==
IH= H GH=H !FH==, IG= FH== GGMG K=H @=FH= HF@
H GHF=G FF HF=@
IG FH== GGMG HH F G=T (F L@, NMH= GGMG) NF-=G
F K=H =GH =@IH= GG GHFHFM (#D)
FH==H = H=@ LHF@ I@=HM GGGGH G F FH==. KK
20142014
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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F F =FH= IH =@H= H=G FH=, G =@HH=:
HH= GHFH.
1.1.3 A@M FFH= HF H ! J@IG GH=H IG= H CD-E# FH==
IH= F @ AF=-CF= F AF= =@M F== (I@H=@M! M 1.159). K 2014K 2014
1.1.4 # @ K=H LHFG IG@ GG R F L@, = MI=@FG, @
K J IHH= F @ K=H IG@ KGH= =GFFG R
=HFFH !FH== K=H IH=. (I IG@ GG K=@@ @ H
JFGH=H= =FG IG@ GG H IFGH=H= H !.)
20082008
1.1.5 AJ=G @ H H H M H = H 12 IFG F J= @ HGH F
!FH==. AJ= @M= H GH @ G@G H GIF HH
HM F F=J FGG M H @FHFM K=H= 12 IFG
JIHIF. 20082008
C8! CC8! C-"!%$ %!% /& GFR-"!%$ %!% /& GFR
1.1.6 JF FIGH F GFI MGHH= C GIFH =G , @==@
@FHF=G GI@ FFH GH=H @FI@F T@HFH= FH
(!MGHH=C) IG= F=H= IH= (G FH= 1.1.7) =
=H= H FFH= H GFI MGHH= C FGI@H. K 2014K 2014
1.1.7 =FJ GGGGH F=G =G (G FH= 1.1.14),
@==@ @FHF=G GI@ IG H CD-E# MGHH= C IH= H GH=H
!MGHH=C. K 2014K 2014
1.1.8 C@==@ @FHF=G GI@ IG MGHH= C GGMG @=FH H H =HFH=@GHF H GIF GFI MGHH= C F MGHH= C-G GH=HG !.
K 2014K 2014
1.1.9 #HFFH !MGHH=C K=H IH= = @ K=H IHF@@ HMF=
=GG IG !MGHH=C J@IG M @G@M @JH = @ K=H
MHMF==G FI = @ K=H MFHMF==G. K 2014K 2014
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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R%0/' !$ %0R%0/' !$ %0%' GFR %' GFR !%!%
1.1.10 C@==@ @FHF=G GI@ FFH ! =HF G K@ IF = =H =G 90 @/
=/1.73 2
F @GG, F G 'FHF H 90 @/=/1.73 2'. K 2014K 2014
1.1.11 # ! =G FHF H 90 @/=/1.73 2, IG =FG = GFI FH==
HFH= F H 20% H =F G==TH FIH= = =M
IH=. K 2014K 2014
1.1.12 #HFFH ! J@IG 60 @/=/1.73 2
F F K=H IH=, F= =
= HH GH=HG ! @GG IFH G H HFI ! =FGG.
20142014
1.1.13 CTF ! FGI@H @GG H 60 @/=/1.73 2
= FG H
FJ=IG@M HGH M FH= H HGH K=H= 2 KG. A@@K F =@=@
@MH=@ JF==@=HM GFI FH== (Q5%) K =HFFH= G =
!. 20082008
W% / % ! #8! CW% / % ! #8! C-"!%$ %!% /& GFR &/ $!'/ /& CKD-"!%$ %!% /& GFR &/ $!'/ /& CKD
1.1.14 CG=F IG= !MGHH=C H ==H=@ =G=G H TF F FI@ IH CD =
@ K=H:
!FH== 45R59 @/=/1.73 2, GIGH= F H @GH 90 MG
FH=IF= (@I=:FH== FH= AC @GG H 3 /@) F HF FF
=M =GG. K 2014K 2014
F =FH= IH =@H= H=G FH=, G =@HH=:
HH= GHFH.
1.1.15 D H =G CD = @ K=H:
!FH== 45R59 @/=/1.73 2
!MGHH=C F H 60 @/=/1.73 2
HF FF =M =GG. K 2014K 2014
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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W% '8 !##W% '8 !##!% %!!% %!% /& GFR !% /& GFR !% % %%%$%$
1.1.16 F =@M IFH GIF ! =G FI=F R F L@, IF=
=HF= HFM = H J@IH= F@ IH= = HH=@
@=J= FG R G=F FF GHF GIF (=I@=, 51CF-EDA,125
#-=H@H F =L@). 20082008
FH=IF=FH=IF=
1.1.17 D H IG FH GHF=G H =H=M FH=IF= I@GG HM F @
G=T@@M GIF= @I= H @K HFH=G LFGG= H FGI@H
G AC. 20082008
1.1.18 HH =H=M FH=IF=, IG IF= AC = FF H
FH=:FH== FH= (C), IG =H G FHF GG=H=J=HM H C F
@K @J@G FH=IF=. F IH=TH= =HF= @J@G
FH=IF= AC 70 /@ F F, C IG G @HFH=J.
AC =G H F H F @ K=H =HG. 2008, 2008,
20142014
1.1.19 F H ==H=@ HH= FH=IF=, = H AC =G HK 3 /@
70 /@, H=G GI@ TF M GIGIH F@M F= G@. #
H ==H=@ AC =G 70 /@ F F, FH G@ H HGH.
2008, 20142008, 2014
1.1.20 F TF AC 3 /@ F F G @==@@M =FHH
FH=IF=. 2008, 20142008, 2014
1.1.21 IH=M IF=FM @I= F IF=FM FH= @GG G = FH= 1.1.18
F:
@ K=H =HG
@ K=HIH =HG K=H ! @GG H 60 @/=/1.73 2. 2008, 2008,
20142014
1.1.22 IH=M M @FHFM HGH= H IF=FM @I= F IF=FM FH= @GG
@ K=H ! 60 @/=/1.73 2
F F = HF =G GHF GIG==
CD (G @G FH= 1.1.28). 20082008
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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"HIF="HIF=
1.1.23 HGH= F H FG HIF=, IG FH GHF=G FHF H
IF= =FGM.
EJ@IH IFHF = HF =G FGI@H 1+ F F.
D H IG IF= =FGM H TF G=H=J FGI@H. 20082008
= =G@H == =G@H =J=G=@ HIF=J=G=@ HIF=
1.1.24 HF =G H H =FH=H FG=GHH =J=G=@ HIF= = H
G FH=IF= F HFG=H HIF=, FF 2 IH 3 G=H=J
FH GHF= HGHG G TFH= FG=GHH =J=G=@ HIF=. 20082008
1.1.25 FG=GHH =J=G=@ HIF=, K=H F K=HIH FH=IF=, GI@ FH
=JGH=H= F IF=FM HFH @=M = FF=H FIG. 20082008
1.1.26 FG=GHH =J=G=@ HIF= = H G FH=IF= GI@ @@K
I I@@M K=H FH HGH= F HIF= (G FH=G 1.1.24
1.1.25), FH=IF= F @I=IF=, ! @ FGGIF =HF= G
@ G H HIF= FG=GHG. 20082008
GI@ HGH F CD GI@ HGH F CD
1.1.27 =HF ! H @GH I@@M = @ FGF= FIG K H
FHL=, GI G @=IF= ===HFG (F L@, M@GF= F
HF@=IG), @=H=I -GHF=@ H=-=UHFM FIG (A#DG). 2008,2008,
2014 2014
1.1.28 F HGH= F CD IG= !FH== AC H @ K=H M H
@@K= F=G HFG:
=HG
MFHG=
IH =M =IFM (G FH= 1.3.9)
F=JGI@F =GG (=G= FH =GG, F= FH =@IF, F=F@JGI@F =GG F FF@ JGI@F =GG)
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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GHFIHIF@ F@ HFH =GG, FIFFH F@ @I@= F FGHH= MFHFM
I@H=GMGH =GGG K=H HH=@ =M =J@JH R F L@, GMGH= @IIG
FMHHGIG
=@M =GHFM -GH =M =GG (! HFM !5) F F=HFM =M
=GG
FHI=GH= HH= HIF=. K 2014K 2014
1.1.29 D H IG , F F H==HM G F=G FFG H HGH @ F CD. #
H G H@= GMF, =HG F MFHG=, H IG
G=HM @ G F=G FF H HGH @ F CD. 2008, 20142008, 2014
1.2 C!:#!/ /& #/# +$%8 $%!%
1.2.1 C@GG=M CD IG= =H= ! AC HF=G (G GF= =
H@ 1). B KF HH:
=FG AC =G GG=H K=H =FG F=G JFG IHG
FG ! =G GG=H K=H =FG F=G JFG IHG
=FG AC FG ! = =H= I@H=@M H F=G JFG
IHG. K 2014K 2014
F =FH= IH =@H= H=G FH=, G =@HH=:
HH= GHFH.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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@ 1 C@GG=TH= F= =@ 1 C@GG=TH= F= =M =GG IG= ! AM =GG IG= ! AC HF=GC HF=G
1.2.2 D H HF= H CD G@@M M . K 2014K 2014
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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##JJGH=H= H IG CD HF== H F=G JGH=H= H IG CD HF== H F=G JFG IHGFG IHG
1.2.3 AF @ H GH@=G H IG CD IF= =F =GIGG= K=H
H FG K=H CD, FH=I@F@M = H IG M HFH@ (F L@,
IF=FM HFH GHFIH=, FHL= FIG F @FI@F =GG). K 2014K 2014
1.2.4 G H FG'G ! AC HF=G (G H@ 1) H ==H H=F F=G
JFG IHG (F L@, CD FFGG=, IH =M =IFM, @@-IG
FH@=HM F=JGI@F JHG) =GIGG H=G K=H H. K 2014K 2014
#=H=G F F@ I@HF#=H=G F F@ I@HFGIGI
1.2.5 F F@ I@HFGI G H @@ @ K=H CD K:
J @FH FFGG= CD (G FH= 1.3.3)
J J=G=@ F FG=GHH =J=G=@ HIF=
J GMHG IF=FM HFH GHFIH=
J =@M =GHFM @MMGH= =M =GG F JF 20 MFG
J ! @GG H 30 @/=/1.73 2
(! HFM !4 F !5)
F G=F M F@=GH H FI=F F@ =GM. 2008, 20142008, 2014
1.2.6 AJ=G @ K=H =@M =GHFM =F=H =M =GG IH H
=@=H=G F@ FGI@H F F@ I@HFGI G =G FF F
H. 20082008
1.3 F%%#8 /& //'
1.3.1 AF H FIM =HF= (!FH== AC) K=H H FG
K=H, F H F=G , CD; F = = HH CD =G H FFGG=J = M @.
K 2014K 2014
1.3.2 G H@ 2 H I= H FIM ! =HF= F @ K=H, F H F=G
, CD, IH H=@F =H H H FG F= H:
H IF@M= IG CD
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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GH HHFG ! AC (IH KF HH CD FFGG= =G H -
@=F)
F==H=G, G=@@M FH =@IF
G H H=F HFHH (GI G F=R=HG=R@GHF GMGH AA
H=GHG, A#DG =IFH=G)
=HFIFFH =@@GG
KHF HM J G GFJH=J H CD. K 2014K 2014
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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@ 2 @ 2 FIM =HF= ! (IF H=G F MFIM =HF= ! (IF H=G F MFF, , M ! AM ! ACC
HFM) F @ K=H, F H F=G HFM) F @ K=H, F H F=G , CD, CD
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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DT= FFGG=DT= FFGG=
1.3.3 DT @FH FFGG= CD G:
GIGH= FG = ! 25% F F = ! HFM K=H=12 HG FF
GIGH= FG = ! 15 @/=/1.73 2
F MF. K 2014K 2014
1.3.4 H @@K= GHG H =H=M H FH FFGG= CD:
H= ==I 3 ! GH=H=G JF F= H @GG H 90 MG.
# @ K=H K T= FI !, FH H ! K=H= 2 KG H L@IIGG IH HF=FH= ! R F L@, IH =M =IFM F GHFH=
F=R=HG= GMGH H=GH HFM. 2008, 20142008, 2014
1.3.5 B KF HH @ K=H CD F H =FG F=G FFGG= H -
GH =M =GG = HM J =HF H @@K=:
GIGH= FG = ! 25% F F JF 12 HG FF
GIGH= FG = ! 15 @/=/1.73 2
F F JF 12 HG. 2008,2008, 2014 2014
1.3.6 GGGG= CD FFGG=, LHF@H H IFFH FH @=
! H H=G =H IH K @= =HFJH= GHFH=G,
FH=I@F@M = =H GIGHG HH H FG =H F@ F@H HFM
= H=F @=H=. 2008, 20142008, 2014
=G HFG GG=H K=H CD FFGG==G HFG GG=H K=H CD FFGG=
1.3.7 F K=H @ K J M H @@K= F=G HFG F CD
FFGG= H H==G H=F @H:
F=JGI@F =GG
FH=IF=
IH =M =IFM
MFHG=
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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=HG
G=
AF=, AF=-CF= F AG= =@M F==
F= IG A#DG
IHFH IF=FM IHUK HFH GHFIH=. K 2014K 2014
1.3.8 # @ K=H CD H F= IG A#DG M GG=H K=H
FFGG= IH IG =G GG=H K=H FJFG=@ FG = !.
ELF=G IH= K HFH= @ K=H CD K=H A#DG JF F@
F=G H=. =HF H HG !, FH=I@F@M = @ K=H @K
G@= ! /F = H FG HF F=GG F FFGG=. 20082008
AIH =AIH =M =IFM CDM =IFM CD
1.3.9 =HF @ F H J@H F FFGG= CD F H @GH
2R3 MFG HF IH =M =IFM, J = GFI FH== G FHIF H
G@=. K 2014K 2014
1.3.10 AJ=G @ K J IH =M =IFM HH HM F H =FG F=G CD J@= F FFGG=. K 2014K 2014
1.4 I&/!/ !$ %$#!/
1.4.1 F @ K=H CD IH= =FH= H=@F H H GJF=HM
IG CD, H GG=H @=H=G H F=G FFGG=. 20082008
1.4.2 J@= =FH= F IH= FFG, =J@J @ K=HCD = H=F J@H F H IHGH. @@K= H=G F GIGH.
H =G CD K G =H H @?
H IGH=G GI@ @ G IH H=F =MG?
H HFHHG F J=@@ F CD, KH F H=F JHG =GJHG
KH @=H=G F G= HG M IF G FGI@H HFHH/=H=?
H @ H =UI H=F K =H=?
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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# KH KMG I@ CD =HG HFHH H @'G =@M @=, G=@ H=J=H=G,
KF FHI=H=G T=@ G=HIH=, =@I= THG @@KG J=@@?
"K @ K=H IGH H CD KH GIFG GM@=@
GIFH F J=@@?
FF=H, F =FH= IH F@ F@H HFM (GI G H
FIM @H H= =@MG=G HFHH GGG=G F LG F-
H=J HFG@HH=) H FFH= FI=F (GI G J= TGHI@ F
F=H@ HHF).
CGFJH=J H K =H M G=F. 20082008
1.4.3F @ K=H CD =-I@=HM =FH= F IH= FFG GFF=H H H GJF=HM H=F =H= H @@K H= F H H I@@M
IFGH =F =G IH H=F HFHH. 20082008
1.4.4 "@HF FGG=@G FJ== =FH= IH= FFG
GI@ GIF HM J G=@=GH K@ IH CD H GGFM
G=@@G H =@=HH @F=. 20082008
1.4.5 "@HF FGG=@G KF= K=H @ K=H CD GI@ H IH
H GM@=@ GHG = K=H H =H= F GG H
FF=H GIFH R F L@, GIFH FIG, IG@@= F G=@=GH
IFG. 20082008
&=GHM@ J=&=GHM@ J=
1.4.6 EIF @ K=H CD H H LF=G, =J @HM K=H GH
G=. 20082008
D%!8 %D%!8 %%/%/
1.4.7 F =HFM J= IH HGG=I, GH, @F= G@H =H
FF=H H H GJF=HM CD. 2008, 20142008, 2014
1.4.8 F =HFM =HFJH= =G F H=G GI@ IF K=H= H HLH
IH=, H=@ =HFM GGGGH GIFJ=G= H GIF @IHF=H=
=G FJH. 20082008
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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L/-0L/-0/% $%/% $%
1.4.9 D H F @K-FH= =HG (=HFM FH= =H @GG H 0.6R0.8 //
M) H @ K=H CD. K 2014K 2014
@-H@-H
1.4.10 EGIF HH GMGHG F = @ H:
=F @ K=H CD H=F =G=G
@ @ K=H CD H GF = =G=-= IH H=F F
GIFH G@-H (H=G =@IG FJ== =FH= IH @ FGGIF,G= GGH=, LF=G, =H ==G) @ @ H =F
=G. K 2014K 2014
1.4.11 !=J @ GG H H=F =@ H (=@I= =G=G, F==H=G, HGH
FGI@HG, HFHHG FFG) HFI =FH= GMGHG, GI G
@ H=H=K, H IF @ H H G@- H=F CD. KK
20142014
1.5 R%&%! #%!
1.5.1 =H IH H ==J=I@'G K=GG F==H=G K G=F=
FFF@. 20082008
1.5.2 @ K=H CD = H @@K= FIG GI@ F@@M FFF F
G=@=GH GGGGH:
! @GG H 30 @/=/1.73 2 (! HFM !4 F !5), K=H F K=HIH =HG
AC 70 /@ F F, I@GG K H IG M =HG @FM
FF=H@M HFH
AC 30 /@ F F (AC HFM A3), HHF K=H HIF=
GIGH= FG = ! 25% F F, = ! HFM F GIGH=
FG = ! 15 @/=/1.73 2
F F K=H= 12 HG
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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MFHG= HH F=G F@M HF@@ G=H H IG H @GH 4
H=MFHG=J FIG H HFIH= GG (G @G "MFHG= #CE I=@=
C!127)
K F GIGH FF F H= IGG CD
GIGH F@ FHFM GHG=G. 2008, 20142008, 2014
1.5.3 CG=F =GIGG= H =GGIG K=H G=@=GH M @HHF, =@ F
H@ = GG KF =H M H GGFM F H FG K=H CD H
G M H G=@=GH. 20082008
1.5.4 FFF@ G @ =H@M F (HK H FG
K=H CD F H=F FF H @HF FGG=@), =H M GG=@ FFIH= @@K-I H H @ H H H=H'G ! GIFFM FHF H =
G=@=GH @==. # H=G =G H G, F=HF= F IHIF FFF@ F F-FFF@ GI@
G=T. 20082008
1.5.5 @ K=H CD F@ IHUK GHFIH= GI@ F@@M FFF H
IF@=@ GFJ=G, I@GG IFH =@ =HFJH= =G FI=F R F
L@, F H HFHH MF@=, GJF IF=, =G=G F UI=
JF@. 20082008
1.6 P!!#/%!08
B@ FGGIF HF@B@ FGGIF HF@
1.6.1 # @ K=H CD = H H GMGH@= @ FGGIF @K 140 "
(HFH F 120R139 ") H =GH@= @ FGGIF @K
90 "3
. 20082008
1.6.2 # @ K=H CD =HG, @G = @ K=H AC 70 /
@ F F, = H H GMGH@= @ FGGIF @K 130 " (HFH
F 120R129 ") H =GH@= @ FGGIF @K 80 "3
.
20082008
C= H=C= H=MFHG=JMFHG=J H H
1.6.3 F @K-GH F=R=HG= GMGH H=GH H @ K=H CD :
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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=HG AC 3 /@ F F (AC HFM A2 F A3)
MFHG= AC 30 /@ F F (AC HFM A3)
AC 70 /@ F F (=FFGH=J MFHG= F F=JGI@F
=GG)4
. K 2014K 2014
1.6.4 D H F =H= F=R=HG= GMGH H=GHG H @
K=H CD. K 2014K 2014
1.6.5 @@K H HFHH FH=G = "MFHG= (#CE I=@=
C!127) F @ K=H CD, MFHG= AC @GG H 30 /
@ (AC HF=G A1 A2), = HM H J =HG. K 2014K 2014
1.6.6 =FJ F, =F @ K F FGF= F=R=HG=
GMGH H=GHG IH H =FH :
=J= H H=@ H@FH G F=R=HG= GMGH H=GHG
=HF= ! GFI HGG=I = =J= H=G G@M. 20082008
1.6.7 # @ K=H CD, GIF GFI HGG=I HFH=G GH=H H
! F GHFH= F=R=HG= GMGH H=GHG. H HG
GIFHG HK 1 2 KG HF GHFH= F=R=HG= GMGH
H=GHG HF G =FG. 20082008
1.6.8 D H FIH=@M F F=R=HG= GMGH H=GH H @ K=H
CD = H=F FHFHH GFI HGG=I HFH= =G FHF H
5.0 @/@=HF. 2008, 20142008, 2014
1.6.9 MF@= F@IG IG F=R=HG= GMGH H=GHG,GGGGH, =JGH=H= HFHH HF HFG K H FH
MF@= GI@ IFH H GFI HGG=I HFH=
F. 20082008
1.6.10 CIFFH FGF=H= FIG K H FH MF@= =G H
HF==H= H H IG F=R=HG= GMGH H=GHG, IH
KF HH F FIH =HF= GFI HGG=I HFH= M
FI=F. 20082008
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
, NICE 2014. A"" &gh' &e'e&*ed. La' #%d-ed Ja$a&+ 2015 Page 31 %f 62
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1.6.11 H F=R=HG= GMGH H=GHG = H GFI HGG=I
HFH= =FGG H 6.0 @/@=HF F F HF FIG K H
FH MF@= J =GH=I. 20082008
1.6.12 @@K= H =HFIH= F G =FG F=R=HG= GMGH
H=GHG, H =M H G = =HF H ! FG F
FHFHH G@= =G @GG H 25% F H GFI FH== =FG F
G@= =G @GG H 30%. 20082008
1.6.13 # HF =G FG = ! F =FG = GFI FH== HF GHFH= F
=FG= H G F=R=HG= GMGH H=GHG, IH =H =G @GG H
25% (!) F 30% (GFI FH==) G@=, FH H HGH = 1R2 KG.
D H =M H F=R=HG= GMGH H=GH G = H =! =G @GG H 25% F H = GFI FH== =G @GG H 30%. 20082008
1.6.14 # H ! =G 25% F F, F H = GFI FH== =G 30% F
F:
=JGH=H HF IGG HF=FH= = F@ IH=, GI G J@I @H=
F IFFH =H= (F L@, A#DG)
= HF IG F H HF=FH= = F@ IH= =G I, GH H
F=R=HG= GMGH H=GH F FI H G H FJ=IG@M H@FH
@KF G, @HFH=J H=MFHG=J =H= = FI=F. 20082008
HH=GHH=G
1.6.15 @@K H FH=G = &== =TH= (#CE I=@= C!181) F
H IG GHH=G = CD. K 2014K 2014
FF@ H=@H@HG H=I@HG@ H=@H@HG H=I@HG
1.6.16 F H=@H@H FIG H @ K=H CD F H GFM FJH=
F=JGI@F =GG, IH KF H =FG F=G @=. KK
20142014
1.6.17 CG=F =L = FF H KFF= = @ K=H TF !
30R50 @/=/1.73 2
-J@JI@F HF=@ TF=@@H= K J 1 F F
H @@K= F=G HFG:
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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F=F GHF F HFG=H =G= HH
75 MFG F @F
MFHG=
=HG @@=HIG
GMHH= FH =@IF. K 2014K 2014
1.7 O% #/0#!/
B H@=G GHFG=GB H@=G GHFG=G
1.7.1 D H FIH=@M GIF @=I, GH, FHMF= F (")
J=H= D @J@G = @ K=H ! 30 @/=/1.73 2
F F (!
HFM !1, !2 F !3). 20082008
1.7.2 GIF GFI @=I, GH " HFH=G = @ K=H
! @GG H 30 @/=/1.73 2
(! HFM !4 F !5). DHF= H
GIGIH FIM HGH= M H GIF J@IG H @==@
=FIGHG. F IH L=GHG, G G=@=GH ==. 20082008
1.7.3 F =GGHG = ==H F H FJH= HFHH
GHFG=G = @ K=H ! 30 @/=/1.73 2
F F (! HFM
!1, !2 F !3). 20082008
V! D 00%% % !!'%% /& CKD9%V! D 00%% % !!'%% /& CKD9%! !$ "/% $/! !$ "/% $/$%$%
DH=@ J= H H CDR=F@ =GFFG =G M H G
H=G I=@=. # IFH=, G J= F MIF @@ F@ GFJ=.
1.7.4 D H FIH=@M F J=H= D GI@HH= H F FJH
CDR=F@ =GFFG. K 2014K 2014
1.7.5 F @@=F@ F F@=F@ H HFH J=H= D T=M = @ K=H
CD J=H= D T=M. K 2014K 2014
1.7.6 # J=H= D T=M G FFH GMHG CDR=F@
=GFFG FG=GH, F @@=@ (1-@-MFLM@@=F@) F
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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@=HF=@ (1-25-=MFLM@@=F@) H @ K=H ! @GG H
30 @/=/1.73 2
(! HFM !4 F !5). K 2014K 2014
1.7.7 =HF GFI @=I GH HFH=G = @ F=J=
@@=@ F @=HF=@ GI@HG. 20142014
A=A=
1.7.8 # H @FM GIF, H @= @J@ = @ K=H !
@GG H 45 @/=/1.73 2
(! HFM !3, !4 F !5) H =H=M =
(@= @GG H 110 /@=HF 11.0 /@, G A= H =
@ K=H F= =M =GG #CE I=@= C!114). DHF= H
GIGIH FIM HGH= M H GIF J@I H @==@=FIGHG. 20082008
FF@ =FH GI@HG = H H H@= =G=G@ =FH GI@HG = H H H@= =G=G
DH=@ J= H H H@= =G=G =G M H G H=G I=@=. #
IFH=, G J= F MIF @@ F@ GFJ=.
1.7.9 CG=F F@ G=I =FH GI@HH= F @ K=H H:
! @GG H 30 @/=/1.73 2
(! HFM !4 F !5)
GFI =FH HFH= @GG H 20 @/@=HF. K 2014K 2014
2!FH== M @GG F@=@ = FH= G=HIH=G (F L@, IH =M =IFM,
FM, HIG GHHG, IG@ KGH= =GFFG, = @ K F @IF=G F
J IHH=) G H K@@ J@=H = FH= H= FIG (F L@, =
@ AG= =@M F==).
3 !D! GF F F=G J= @ FGGIF HF@, = H GH IH H
GH@=G T=H=J G FG @ FGGIF = CD. J= FGH = H I@@
I=@= G H HFF =@I GHM @K @ FGGIF, IH G GI J= G
L=GH. !D! GH IH F @ FGGIF HFHG, =J = HG FH=G, K= =
H=F @==@ LF= K=@@ =F FH= = CD.
4
J= H GIFH HG F=HF= =G @==H = @ JF 70 MFG.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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22 #@HH=: HH= GHFH#@HH=: HH= GHFH
=G GH= =@=HG G =FHH G H FH= HH M FGI@H F =@H= H=G
I=@=, K= KF =H=T H H H= I@=H= = $I@M 2014. =H =IH F
GH@FG, LFHG @H FGG=@G, 3 FG KF =H=T HH M J = =H
FH= F I@ @@= H =@H. "KJF, HF G H FH= M
H I@@M =@H H I=@=.
F=FM F FJ=FG, @FHFM GFJ=G H=F FGH=J =GG=FG M FH=I@F@M
H M HG G.
2.1 C!#!' %!% /& #%!%-"!%$ '/%! :!/ !% (GFR)
FH= 1.1.2.
HH=@ =H =@HH=HH=@ =H =@HH=
CF= =M D=GG E==@M C@@FH= (CD-E#) FH== IH= =G F
IFH H H =TH= D=H = @ D=GG (DD) HIM IH=, =G @GG =G H
! F H 60 @/=/1.73 2
FFG HHF = @ 75 MFG JF.
IG H DD HIM IH= M JF-=G CD. G= H CD-E# IH= =GH
I@ TH H=HG @===G M FI= IGGFM =HHG, FI= H=HG'
FG FI= H JF@@ IF CD = H I@H=.
C@@G F =@HH=C@@G F =@HH=
&FHF=G IG= H DD HIM IH= H GH=H ! M H H=F
FH=.
G= H CD-E# FH== IH= H GH=H ! M =H =TI@H H GGGG HFGJF H= = @ K=H FJ=IG ! GH=HG @I@H IG= HF IH=G.
&FHF=G M H IH H=F GHKF H =@I H CD-E# FH== IH= G
HH =H =G IG IHH=@@M.
IFH F =@HH=IFH F =@HH=
@= H@G IG H =J GH=HG ! IG= H DD HIM IH= (F
L@, HG FI M H @ AGG=H= H H=@ =M D=GG EIH=FF H DD.), F F=G K=H CD-E# FGI@HG.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
, NICE 2014. A"" &gh' &e'e&*ed. La' #%d-ed Ja$a&+ 2015 Page 35 %f 62
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AGG=H= C@==@ B==GHFM &FHFM ==, & GHG @=
H H=@ ELHF@ I@=HM AGGGGH FJ= F F=G= KFGG H
=@I =H = @FHFM =GH= FKFG.
&@ @==@ =GG== FIG I@ HH H=F @@ @FHFM H @ GIF HHH=G =G =FFH =H FH=.
2.2 U' #8! C-"!%$ %!% /& GFR
FH= 1.1.14.
HH=@ =H =@HH=HH=@ =H =@HH=
EGH=HG ! (!) G GFI MGHH= C J =F G=T=HM F G==TH =GG
IHG H HG G GFI FH==. F @ K=H FF@= =G=G,
!MGHH=C =G =H=@ =GH= H@ HH M FI JF =G=G. G= H=G H@ M
FGI@H = G==TH FFH= @ @GG=T G J= GH 3 CD = F@GG=T G H
J= CD (!1A1 F !2A1). =G I@ TH H=HG @===G M FI= IGGFM
=HHG, FI= H=HG' FG FI= H JF@@ IF CD = H
I@H=. =G =H=@ HGH M J GH =H, IH HF K=@@ T=@ THG, K=H
KF =GG @= H FI H GHG.
C@@G F =@HH=C@@G F =@HH=
CMGHH= C HGH= =G K FH= G F=FM F HG M H KF
K H FIGH H=G HGH.
CMGHH= C HGH= M H K=@M J=@@. &FHF=G M H =JGH = HF== ,
= G GG, I=H.
G= MGHH= C G =H=@ HGH K=@@ J T=@ =H. BG GH=H ,=G=G =H H IH KHF @@ @FHF=G F G=H @FHF=G
F H=G HGH. CGHG K=@@ JFM, GI@ GGGG @@@M = H @
FJ=G=.
IFH F =@HH=IFH F =@HH=
=G HGH @M G H FF = T I@H= (G F = 1.1.14)
F@@M @M F FG.
GGM F MGHH= C FF IG= L=GH= @MGFG.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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C@===G F @=@M H K@ H =HFIH= F IFH HGH F ! IG
M H IH H FJ=IG@M F =GH= F=HF= F F@M CD.
H #CE GH= GHHH F IFHF =FH= J= GHG.
2.3 C!&8' #/# +$%8 $%!%
FH= 1.2.1.
HH=@ =H =@HH=HH=@ =H =@HH=
BH @I=:FH== FH= (AC) ! ==H H F=G JFG JHG CD
FFGG=, IH K IG HHF, F=G GHFH=TH= IFM =G =FG. F IFH
@GG=TH= CD M @ H F HFH HFHH =HF=.
C@@G F =@HH=C@@G F =@HH=
GH= F H ! AC M LHF IF GH H =G=G =HF=.
=H= AC G @GG=TH= CD F @L HG IG= CD GHG
K=@@ H H=F FH=.
IFH F =@HH=IFH F =@HH=
@GG=TH= H@ GKG K H ! HF=G (!1R!5, K= J H G !
HFG@G G H CD GHG 1R5 F FJ=IG@M), AC HF=G (A1RA3)
GI@ =, F L@:
A FG K=H ! 25 @/=/1.73 2
AC 15 /@ G CD
!4A2!4A2.
A FG K=H ! 50 @/=/1.73 2
AC 35 /@ G CD!3A3!3A3.
A @F=H =G J=@@ H @ @HF FGG=@G IFGH K H HFM
CD GI@ HF= H LH GHG F H (G @F=H B = H #CE FGIFG
F @@ FH=).
=G AC =G KFI@ =H FF H F=G JFG IHG = CD, H
IG AC ! = =H= K=@@ @@K HHF F=G GHFH=TH=.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
, NICE 2014. A"" &gh' &e'e&*ed. La' #%d-ed Ja$a&+ 2015 Page 37 %f 62
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2.4 F% %/#%
IFHF FGIFG F J=@@ F #CE HH M @ H GIFH =@HH=.
A @==@ K@ GIFM F= =M =GG (H =H=) =G J=@@ K=H H=@G
H J= I= F F=FM F.
H=@ CF= =M D=GG AI=H =@H (DF 2014) =G H =FJ =G=G =
F=FM F, H IFGH H GHF H=H F =HG JF=H=, H F=J
=FJHG IG= @HF= H=H H GMGHG.
#CE FIG ==HFG I@@M F IG = H I@=HM IHG FKF () F H
. FGG F H=G H #CE I F J=@@.
H H IH I=@= FH=G I@=HM GHF GIFG F J=@@ H
#CE KG=H.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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33 GF FH=GGF FH=G
!I=@= DJ@H !FI G H @@K= FH=G F FGF, G
=HG FJ=K J=, H =FJ #CE I= H=H F = H IHIF.
3.1 S%&-!!'%%
DG H FJ=G= IH=@ GIFH=J =HFJH=G H @ K=H F= =M
=GG (CD) M @HF FGG=@G =FG H=HG' G=@@G T = =
H=F =H=G =FJ @==@ IHG?
M H=G =G =FHHM H=G =G =FHH
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G=F @==@@M G==TH
FH=IF= H FGH K
H AC =G 30 /@ F
F (H=G =G FL=H@M
I=J@H H C 50 /@
F F, F IF=FM FH=
LFH= 0.5 /24 F
F).(1.1.13)
F TF
AC 3 /@ F
F G @==@@M
=FHH FH=IF=.
(1.1.20)
@ K=H FH=
1.1.20.
F=HF= F @==@@M G==TH
FH=IF= J F
AC 30 /@ F F H
3 /@ F F. A@HI H=G
IGH= KG H =FH@M =@I =
H IH, H F
J= FJ=K F H FFG
=M @GG=TH=
CD GH=G. !D! F
HH H F=G JFG IHG =G
H=II GHFHG H AC
K@@ @K 30 /@.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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# @ K=H =HG
G=F =F@I=IF=
(AC F H 2.5 /@
= AC F H
3.5 /@ = K) H
@==@@M G==TH. (1.1.14)
F TF
AC 3 /@ F
F G @==@@M
=FHH FH=IF=.
(1.1.20)
@ K=H FH=
1.1.20
F=HF= F @==@@M G==TH
FH=IF= J F AC 30 /@ F F H
3 /@ F F. A@HI H=G
IGH= KG H =FH@M =@I =
H IH, H F
J= FJ=K F H FFG
=M @GG=TH=
CD GH=G. !D! F
HH H F=G JFG IHG =G
H=II GHFHG H AC
K@@ @K 30 /@. F =G
F@ J KM F H HF
'=F@I=IF=' (AC HK 3
30 /@) H !D!
KH H @HGH FH=G
H FUH H=G.
A=H=@@M =H KG @F @H
FF=H H J =FH
F=HF= F F. !D! KG H
KF M J= K= H
F =FG KF G.
A@@ @ K=H =HG,
@ K=HIH =HG K=H
! @GG H 60 @/=/
1.73 2, GI@ J H=F
IF=FM @I=/FH=
LFH= IH=T. TFGH
F@ FGI@H GI@
TF F@M F=
G@ (= H FJ=IG@M
H=).(1.1.15)
IH=M IF=FM
@I= F IF=FM
FH= @GG G =
FH=
1.1.18 F:
@ K=H
=HG
@ K=HIH
=HG K=H
! @GG H
60 @/=/1.73 2
(1.1.21)
G FH H F==@
FH= (FF=
TF= F@M F=
G@) KG FJ IG
=T F=HF= F FJ= =
FH= 1.1.19.
HF G F @F=TH= @M
R G @F=TH= H@.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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=HF ! = @
FGF= FIG K H
FHL= GI G @=IF=
===HFG @=H=I. C
! H @GH I@@M = @
F=J= @-HF GMGH=
-GHF=@ H=-
=UHFM FI (A#D)
HFHH. (1.1.21)
=HF ! H @GH
I@@M = @
FGF= FIG
K H
FHL=, GI G
@=IF= ===HFG
(F L@
M@GF= F
HF@=IG), @=H=I
-GHF=@
H=-=UHFM
FIG (A#DG).
2008,
2014
FIM =HF= KG
F FHL= FIG G
H BF=H=G H=@ FI@FM,
K= @F ==HG
=F = =HF= G
HK A#DG HF
FHL= FIG. AI@
=HF= KG F M H !D!
G FF=H F @@ HG FIG.
EL@G @=IF= ===HFG
KF F @F=TH=.
# H G H J F=G
HFG, H IG , F
F H==HM G F=G FFG H
HGH @ F CD. # H
G H@=
GMF, =HG F
MFHG=, H IG
G=HM @ G F=G FF
H HGH @ F CD. (1.1.23)
D H IG ,
F F H==HM G
F=G FFG H HGH
@ F CD. # H
G H@=
GMF, =HG F
MFHG=, H
IG G=HM @ G
F=G FF H HGH
@ F CD.
(1.1.29)
==H=@ FH H GH '#
H G H J F=G
HFG' KG FJ.
2008 FH= =@=
HH = F=G HFG KF FGH H
, F H==HM I@ G=F G F=G HFG. !D!
= H T M J= F H=G
F HH FKF= H
FH= FHG I@=HM.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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F H IFGG H=G
@GG=TH= T FH=IF=
G IF=FM AC 30 /@ F
F, F C 50 /@ F
F (FL=H@M
I=J@H H IF=FM FH=
LFH= 0.5 /24 IFG F
F). (1.2.2)
F TF
AC 3 /@ F
F G @==@@M
=FHH FH=IF=.
(1.1.20)
F=HF= F @==@@M G==TH
FH=IF= J F
AC 30 /@ F F H
3 /@ F F. A@HI H=G
IGH= KG H =FH@M =@I =
H IH, H F
J= FJ=K F H FFG
=M @GG=TH=
CD GH=G. !D! F
HH H F=G JFG IHG =G
H=II GHFHG H AC
K@@ @K 30 /@.
I=J@G H C IF=FM
FH= LFH= KF FJ
IG H J= GK HH
AC KG F IFH.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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F F@ I@HFGI H @@
@ K=H CD K:
J FFGG=J CD
(! @= F H5 @/=/1.73
2K=H=
1 MF, F F H 10 @/
=/1.73 2
K=H= 5 MFG)
J J=G=@ F FG=GHH
=J=G=@ HIF=
J GMHG IF=FM
HFH GHFIH=
J =@M =GHFM
@MMGH= =M =GG
F JF 20
J GH 4 F 5 CD
F G=F M
F@=GH H FI=F
F@ =GM. (1.4.1)
F F@
I@HFGI G H @@
@ K=H CD K:
J @FHFFGG=
CD (G
FH=
1.3.3)
J J=G=@ F
FG=GHH =J=G=@
HIF=
J GMHG
IF=FM HFH
GHFIH=
J =@M
=GHFM
@MMGH= =M
=GG F
JF 20 MFG
J ! @GG
H 30 @/=/
1.73 2
(!
HFM !4 F !5)
F G=F M
F@=GH H
FI=F F@
=GM. (1.2.5)
TFGH I@@H =H KG =T H
FUH H IH I=@=
T=H= FFGG= G
H J= FJ=K = H
FIM =HF= GH= (G
FH= 1.3.5).
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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H @@K= GHG H
=H=M FFGG=J CD.
H= ==I HF
! GH=H=G JF F= H @GG H
90 MG.
# @ K=H K T=
FI !, FH H
! K=H= 2 KG H
L@I IGG IH
HF=FH= ! R F
L@, IH =M =IFM
F ==H=H= ACE
===HF/AB HFM.
DT FFGG= G
@= = ! F
H 5 @/=/1.73 2
K=H= 1 MF, F F H
10 @/=/1.73 2 K=H=
5 MFG.
IG FH=I@F@M HG
= K @= !
H=I= H H GFJ
FH KI@ @ H H
F F@ F@H
HFM K=H= H=F @=H=
M LHF@H= H IFFHFH @=. (1.5.1)
H @@K=
GHG H =H=M H
FH FFGG=
CD:
H= ==I
3 !
GH=H=G JF
F= H @GG
H 90 MG.
# @ K=H
K T=
FI !,
FH H !
K=H= 2 KG H
L@I IGG
IH
HF=FH=
! R F L@,
IH =M =IFM
F GHFH=F=R=HG=
GMGH H=GH
HFM. (1.3.4)
B KF HH @
K=H CD F H
=FG F=G
FFGG= H -
GH =M =GG =
HM J =HF
H @@K=:
GIGH=
FG = !
25% F F JF
12 HG F
TFGH 2 I@@H =HG H 2008
FH= KF =H
GFH FH= (1.3.4) H
G=G H FGG H =H=M
FFGG=J CD.
H=F I@@H =H KG IH
(1.3.5) G J= F=J
F H FIM =HF=
FJ=K, K= =H=T HFG@G
F FFGG=.
!D! GFH
FH= (1.3.6) F HIFH I@@H =H H =J =H
=H=@ IG, @F=T H
KF= F= H #CE IG
GHM@.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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GIGH=
FG = !
15 @/=/1.73 2
F F JF
12 HG. (1.3.5)
GGGG= CD
FFGG=,
LHF@H H
IFFH FH @=
! H H=G
=H IH K
@= =HFJH=GHFH=G,
FH=I@F@M = =H
GIGHG HH H
FG =H
F@ F@H
HFM = H=F
@=H=. (1.3.6)
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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@ K=H CD = H
@@K= FIG GI@
F@@M FFF F
G=@=GH GGGGH:
GH 4 5 CD (K=H F
K=HIH =HG)
=F @J@G FH=IF=
(AC 70 /@ F F,
FL=H@M I=J@H H
C 100 /@ F F,
F IF=FM FH= LFH=
1 /24 F F) I@GG
K H I H =HG
@FM FF=H@M
HFH
FH=IF= (AC 30 /
@ F F,
FL=H@M I=J@H H
C 50 /@ F F,
F IF=FM FH= LFH=
0.5 /24 F F) HHF
K=H HIF=
F=@M @== !
(F H 5 @/=/
1.73 2
= 1 MF, F F
H 10 @/=/1.73 2
K=H= 5 MFG)
MFHG= HH F=G
F@M HF@@ G=H
H IG H @GH IF
H=MFHG=J FIG H
HFIH= GG (G @G
'"MFHG=: H
MFHG= = I@HG =
@ K=H CD =
H @@K= FIG
GI@ F@@M
FFF F G=@=GH
GGGGH:
! @GG H
30 @/=/1.73 2
(! HFM !4
F !5), K=H F
K=HIH =HG
AC 70 /@
F F (AC
HFM A3),
I@GG K H
IG M =HG
@FM
FF=H@M
HFH
AC 30 /@
F F (AC
HFM A3),
HHF K=H
HIF=
GIGH= FG
= ! 25% F
F
= ! HFM FGIGH= FG
= ! 15 @/
=/1.73 2
F
F K=H=
12 HG
MFHG= HH
F=G F@M
TFGH I@@H =H KG
H =J ! J@IG FHF H H
GHG H @ @F=M H F=HF=.
# H G I@@H =H HI=J@ H C J@I KG
FJ H GIF G=GHM
AC IG.
# H IFH I@@H =H H
T=H= FFGG= KG
H H 2014 T=H= (G
FH= 1.3.5).
TH I@@H =H KG H FGG FF H IFFH #CE
I=@= MFHG=.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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F=FM F' #CE
I=@= C!34)
@ K=H, F GIGH
J=, FF F H=IGG CD
GIGH F@ FHFM
GHG=G. (1.6.1)
HF@@ G=H
H IG H @GH 4
H=MFHG=J
FIG H
HFIH= GG
(G @G
"MFHG=
#CE I=@=
C!127)
K F
GIGH FF
F H= IGG CD
GIGH F@
FHFM GHG=G.
2008,
2014 (1.5.2)
F =HFM J= H @
K=H FFGG=J CDF= HGG=I,
GH, FH=, @F=
G@H =H K ==H.
(1.7.4)
F =HFM J=
IH HGG=I,GH, @F=
G@H =H
FF=H H H
GJF=HM CD.
(1.4.7)
FH= KG FJ IG H=G
KG GIH H K J=FJ=K.
!D! FKF H
FH= H GHH HH
J= GI@ FF=H H H
GH CD IG 'FFGG=J
CD' KG G=F H
=IIG G =H I@ FF H
M K=H CD.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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ACE ===HF/AB HFM
GI@ H F@@M GHFH
= H FHFHH GFI
HGG=I HFH= =G
G==TH@M J H F@
FF F (HM=@@M F
H 5.0 @/@=HF). (1.8.11)
D H FIH=@M F
F=R=HG=
GMGH H=GH H
@ K=H CD =
H=F FHFHH
GFI HGG=I
HFH= =G
FHF H
5.0 @/@=HF. (1.6.8)
FH= KG
F @F=HM H FI H
IFH=HM =@= M =
'G==TH@M J H F@
FF F' H 'FHF H
5.0 @/@=HF'.
S%' /& %#/%$!/
FH=G K=H F FH=HM H HFG. !I=@= DJ@H
!FI G FH= G H HF- HK H THG FG
=HFJH=, H= =H IH H I@=HM H IF== J=. F G =HFJH=G,
H !I=@= DJ@H !FI =G TH HH, =J H =FH= =H G @ H, GH
H=HG KI@ G H =HFJH=. KF= IG = H FH=G = H=G I=@=
HG H FH=HM K=H K= H FH= =G (H GHFH H
FH=).
F @@ FH=G, #CE LHG HH HF =G =GIGG= K=H H H=H IH H F=GG
THG H =HFJH=G, H=F J@IG FFG. =G =GIGG= =G H @ H H
F I@@M =F =G= (G @G H=H-HF F).
#HFJ#HFJH=G HH IGH (H=G HH IGH (F IGH H) IGF IGH H) IG
IGI@@M IG 'IGH' F 'IGH H' @M = HF =G @@ IHM H @M H FH=.
G=@@M K IG 'IGH' (F 'IGH H') = H GIG H @@K= H
FH= I@ LHF@M GF=IG F HH=@@M @= HFH=.
#HFJ#HFJH=G HH GI@ (H=G HH GI@ (F GI@ H) IG R 'GHF' FH=F GI@ H) IG R 'GHF' FH=
IG 'F' ( G==@F KFG GI G 'FF' F 'J=G') K K F TH HH, F H JGH
F=HM H=HG, =HFJH= K=@@ F H F, GH H=J. IG
G==@F FG KFG (F L@, 'D H FS') K K F TH HH =HFJH=
K=@@ H TH F GH H=HG.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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#HFJ#HFJH=G HH I@ IGH=G HH I@ IG
IG 'G=F' K K F TH HH =HFJH= K=@@ F H F F
GH H=HG, GH H=J, IH HF H=G M G==@F@M GH H=J. =
=HFJH=, KHF F H H J H =HFJH= H @@, =G F @=@M H HH=H'G J@IG FFG H F GHF FH=, G H @HF
FGG=@ GI@ G F H= G=F= =GIGG= H H=G K=H H H=H.
H= KF= = I=@= IHGH= KF= = I=@= IHG
#CE IG= H=G F H H H GHFH FH=G = I=@=G HH
GHFH J@H HF I@=H= H 2009 JFG= ' I=@=G I@' ($IFM
2009). =G G H @M H M FH=G = 2008 (G IH =FH= F
H=@G IH K FH=G F @@@). # FH=I@F, F FH=G @@@
2008, H KF 'G=F' M H GGF=@M IG H H H GHFH H
FH=.
O% %/ /& '$%%
I@@ I=@=, CF= =M =GG, H=G H=@G H HG J= IG H
J@ H I=@=. #H =G I@=G M H H=@ C@==@ !I=@= CHF.
FH=G F H=G I=@= J =FFH =H #CE HKM.
J FI =FH= F H I@= IH H=G I=@=.
I0%%!/
#@HH= H@G FGIFG H @ MI IH H I=@= =H FH= F @G J=@@.
/ %0/"8
=G I= FFGHG H J=K #CE, K= KG FF=J H HF FI@ G=FH= H
J= J=@@. "@HF FGG=@G F LH H H =H I@@M =H IH K
LF=G= H=F @==@ IH. "KJF, H I= G H JFF= H ==J=I@
FGG==@=HM @HF FGG=@G H =G=G FF=H H H =FIGHG
H ==J=I@ H=H, = GI@HH= K=H H H=H /F IF= F FF, =F M
H GIF=G FIH FHF=GH=G M FIG.
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
, NICE 2014. A"" &gh' &e'e&*ed. La' #%d-ed Ja$a&+ 2015 Page 61 %f 62
http://www.nice.org.uk/guidance/CG182/chapter/About-this-guideline#update-informationhttp://www.nice.org.uk/Guidance/CG182/Evidencehttp://pathways.nice.org.uk/pathways/chronic-kidney-diseasehttp://www.nice.org.uk/guidance/CG182/InformationForPublichttp://www.nice.org.uk/Guidance/CG182/Resourceshttp://www.nice.org.uk/Guidance/CG182/Resourceshttp://www.nice.org.uk/guidance/CG182/InformationForPublichttp://pathways.nice.org.uk/pathways/chronic-kidney-diseasehttp://www.nice.org.uk/Guidance/CG182/Evidencehttp://www.nice.org.uk/guidance/CG182/chapter/About-this-guideline#update-information7/25/2019 CG182 NICE Guidance 20150309
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#@HH= H=G I= =G H FGG==@=HM @@ =GG=FG /F FJ=FG.
C=GG=FG FJ=FG F F= HH =H =G H=F FGG==@=HM H =@H H
I=, = H=F @@ HLH, = @=H H=F IH=G H J I FF H H H @==H
I@KI@ =GF==H=, J I@=HM FHI=HM GHF F@H=G. H= = H=G
I= GI@ =HFFH = KM HH KI@ =G=GHH K=H @= K=H HG
IH=G.
C/08'
P H=@ #GH=HIH F "@H CF EL@@ 2014. A@@ F=HG FGFJ. #CE MF=H
HF=@ K@ F F=JH FGF GHIM, M FFI F IH=@
H-F-FTH IFGG. FFIH= M F F F=@ F=GH=G, F F
F=@ IFGG, =G @@K K=HIH H KF=HH F=GG= #CE.
#B: 978-1-4731-0640-6
A##%$!/
Ch&%$c !d$e+ d'ea'e $ ad"': a''e''#e$ a$d #a$age#e$ (CG182)
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