KDIGO:慢性肾病患者血压管理的指南更新

2021-02-25 MedSci原创 MedSci原创

慢性肾脏病(又称慢性肾功能不全或慢性肾衰竭、CKD),指肾功能在几个月或若干年期间逐渐而难以逆转的衰退。据估计,

慢性肾脏病(又称慢性肾功能不全或慢性肾衰竭、CKD),指肾功能在几个月或若干年期间逐渐而难以逆转的衰退。据估计,慢性肾病患者占美国成年人口的13%,而大多数患者对自身病情往往并不自知。

目前,国际上主要根据肾小球滤过率(GFR)对慢性肾脏病情的划分为:

  • 第1期。肾功能正常,微量蛋白尿,GFR:≧90 mL/min/1.73 m2;
  • 第2期。轻度慢性肾衰竭,GFR:60 - 89 mL/min/1.73 m2;
  • 第3期。中度慢性肾衰竭,GFR:30 - 59 mL/min/1.73 m2;
  • 第4期。重度慢性肾衰竭,GFR:15 - 29 mL/min/1.73 m2;
  • 第5期。末期肾脏病变,GFR:<15 mL/min/1.73 m2。

CKD的主要症状包括水肿、蛋白尿、血尿,长期CKD会导致高血压、贫血、营养不良、血管疾病等并发症。其中高血压不仅是CKD的合并症,同时也是CKD发生的重要病因,因此CKD患者控制高血压显得尤为重要。

近日,国际改善全球肾脏病预后组织(KDIGO)发布了2021慢性肾脏病血压管理临床实践指南。该指南主要包括20项实践要点及12项临床推荐。范围包括原指南中涵盖的主题,如最佳血压目标、生活方式干预和未接受透析的CKD患者的抗高血压治疗,包括肾移植受者和儿童等特殊人群。此外,本指南还引入了一章专门介绍正确的血压测量。

1.      血压测量:

1) 标准化的诊室血压测量用于成人高血压的管理(1B);

2) 除外标准诊室血压测量,还应进行动态血压监测(ABPM)或家庭血压监测(HBPM)以更好管理高血压(2B);

2.      生活方式干预降低未接受透析的慢性肾脏病患者的血压:

1) 建议高血压和慢性肾病患者的钠摄入量目标为每天< 2 g(或每天< 90 mmol,或每天< 5 g氯化钠) (2C)

2) 建议高血压和慢性肾病患者进行中等强度的体力活动,每周累计至少150分钟,或达到与其心血管和身体耐受性相适应的水平(2C);

3.      未接受透析的慢性肾脏病患者血压管理:

1) 建议患有高血压和慢性肾脏病的成年人,进行标准的诊室血压测量值,血压控制目标为收缩压<120mmHg (2B);

2) 建议对高血压、慢性肾脏病和中度至重度蛋白尿糖尿病患者开始RASi治疗(1B);

4. 肾移植患者的血压管理:

1)建议在成人肾移植受者中使用二氢吡啶类钙通道阻滞剂(CCB)或ARB作为一线抗高血压药(1C);

2)高血压的成年肾移植接受者的降压目标为收缩压<130 mm Hg,舒张压<80 mm Hg。

5.      慢性肾脏病患儿的血压管理:

1)建议患有慢性肾病的儿童,ABPM测量的24小时平均动脉压应降低至年龄、性别和身高的50%以下 (2C)。

(推荐等级说明:建议强度分为1级(推荐)或2级(建议);支持证据质量分为A(高)、B(中等)、C(低)或D(非常低))。

 

参考文献:

KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney International (2021) 99, S1–S87.

 

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createdName=12498e5fm12(暂无昵称), createdTime=Sat Feb 27 03:34:14 CST 2021, time=2021-02-27, status=1, ipAttribution=)]
    2022-01-26 ms5000001649854049

    这篇文章对我工作及临床经验积累有很多帮助

    0

  2. 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createdName=12498e5fm12(暂无昵称), createdTime=Sat Feb 27 03:34:14 CST 2021, time=2021-02-27, status=1, ipAttribution=)]
    2022-01-16 白丽萍

    学习了

    0

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createdName=12498e5fm12(暂无昵称), createdTime=Sat Feb 27 03:34:14 CST 2021, time=2021-02-27, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1188457, encodeId=b753118845ef4, content=这篇文章对我工作及临床经验积累有很多帮助, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f5ef6482787, createdName=ms5000001649854049, createdTime=Wed Jan 26 23:29:00 CST 2022, time=2022-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1184924, encodeId=61d0118492465, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0411309316, createdName=白丽萍, createdTime=Sun Jan 16 19:31:51 CST 2022, time=2022-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025897, encodeId=2f41202589e69, content=<a href='/topic/show?id=a91d82583bf' target=_blank 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09:11:30 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999660, encodeId=5e6d999660ee, content=非常实用。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210427/b594a756d77e4171b5313e531ef89b43/31c000a8a97d4872b698c80fb8a33369.jpg, createdBy=624b2152505, createdName=大叔默默路过, createdTime=Thu Jul 15 08:57:42 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976660, encodeId=4e449e666043, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a272265480, createdName=12192b1am98暂无昵称, createdTime=Fri Jun 25 00:01:11 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988274, encodeId=572719882e48d, content=<a href='/topic/show?id=327e563967e' target=_blank style='color:#2F92EE;'>#指南更新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56396, encryptionId=327e563967e, topicName=指南更新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04ce158, createdName=lxg951, createdTime=Tue Oct 12 15:34:14 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344340, encodeId=603513443408a, content=<a href='/topic/show?id=683a88964b0' target=_blank style='color:#2F92EE;'>#血压管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88964, encryptionId=683a88964b0, topicName=血压管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=793a2500200, createdName=12498e5fm12(暂无昵称), createdTime=Sat Feb 27 03:34:14 CST 2021, time=2021-02-27, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1188457, encodeId=b753118845ef4, content=这篇文章对我工作及临床经验积累有很多帮助, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f5ef6482787, createdName=ms5000001649854049, createdTime=Wed Jan 26 23:29:00 CST 2022, time=2022-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1184924, encodeId=61d0118492465, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0411309316, createdName=白丽萍, createdTime=Sun Jan 16 19:31:51 CST 2022, time=2022-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025897, encodeId=2f41202589e69, content=<a href='/topic/show?id=a91d82583bf' target=_blank 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09:11:30 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999660, encodeId=5e6d999660ee, content=非常实用。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210427/b594a756d77e4171b5313e531ef89b43/31c000a8a97d4872b698c80fb8a33369.jpg, createdBy=624b2152505, createdName=大叔默默路过, createdTime=Thu Jul 15 08:57:42 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976660, encodeId=4e449e666043, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a272265480, createdName=12192b1am98暂无昵称, createdTime=Fri Jun 25 00:01:11 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988274, encodeId=572719882e48d, content=<a href='/topic/show?id=327e563967e' target=_blank style='color:#2F92EE;'>#指南更新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56396, encryptionId=327e563967e, topicName=指南更新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04ce158, createdName=lxg951, createdTime=Tue Oct 12 15:34:14 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344340, encodeId=603513443408a, content=<a href='/topic/show?id=683a88964b0' target=_blank style='color:#2F92EE;'>#血压管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88964, encryptionId=683a88964b0, topicName=血压管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=793a2500200, createdName=12498e5fm12(暂无昵称), createdTime=Sat Feb 27 03:34:14 CST 2021, time=2021-02-27, status=1, ipAttribution=)]
    2021-11-25 1228d32am78(暂无昵称)

    学习了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1188457, encodeId=b753118845ef4, content=这篇文章对我工作及临床经验积累有很多帮助, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f5ef6482787, createdName=ms5000001649854049, createdTime=Wed Jan 26 23:29:00 CST 2022, time=2022-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1184924, encodeId=61d0118492465, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0411309316, createdName=白丽萍, createdTime=Sun Jan 16 19:31:51 CST 2022, time=2022-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025897, encodeId=2f41202589e69, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Thu Jun 10 05:34:14 CST 2021, time=2021-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055983, encodeId=785f205598317, content=<a href='/topic/show?id=d088536467a' target=_blank style='color:#2F92EE;'>#慢性肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53646, encryptionId=d088536467a, topicName=慢性肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Jan 27 05:34:14 CST 2022, time=2022-01-27, status=1, ipAttribution=), 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09:11:30 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999660, encodeId=5e6d999660ee, content=非常实用。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210427/b594a756d77e4171b5313e531ef89b43/31c000a8a97d4872b698c80fb8a33369.jpg, createdBy=624b2152505, createdName=大叔默默路过, createdTime=Thu Jul 15 08:57:42 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976660, encodeId=4e449e666043, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a272265480, createdName=12192b1am98暂无昵称, createdTime=Fri Jun 25 00:01:11 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988274, encodeId=572719882e48d, content=<a href='/topic/show?id=327e563967e' target=_blank style='color:#2F92EE;'>#指南更新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56396, encryptionId=327e563967e, topicName=指南更新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04ce158, createdName=lxg951, createdTime=Tue Oct 12 15:34:14 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344340, encodeId=603513443408a, content=<a href='/topic/show?id=683a88964b0' target=_blank style='color:#2F92EE;'>#血压管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88964, encryptionId=683a88964b0, topicName=血压管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=793a2500200, createdName=12498e5fm12(暂无昵称), createdTime=Sat Feb 27 03:34:14 CST 2021, time=2021-02-27, status=1, ipAttribution=)]
    2021-07-16 零文芬

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1188457, encodeId=b753118845ef4, content=这篇文章对我工作及临床经验积累有很多帮助, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f5ef6482787, createdName=ms5000001649854049, createdTime=Wed Jan 26 23:29:00 CST 2022, time=2022-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1184924, encodeId=61d0118492465, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0411309316, createdName=白丽萍, createdTime=Sun Jan 16 19:31:51 CST 2022, time=2022-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025897, encodeId=2f41202589e69, content=<a href='/topic/show?id=a91d82583bf' target=_blank style='color:#2F92EE;'>#肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82583, encryptionId=a91d82583bf, topicName=肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Thu Jun 10 05:34:14 CST 2021, time=2021-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055983, encodeId=785f205598317, content=<a href='/topic/show?id=d088536467a' target=_blank style='color:#2F92EE;'>#慢性肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53646, encryptionId=d088536467a, topicName=慢性肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Jan 27 05:34:14 CST 2022, time=2022-01-27, status=1, ipAttribution=), 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09:11:30 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999660, encodeId=5e6d999660ee, content=非常实用。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210427/b594a756d77e4171b5313e531ef89b43/31c000a8a97d4872b698c80fb8a33369.jpg, createdBy=624b2152505, createdName=大叔默默路过, createdTime=Thu Jul 15 08:57:42 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976660, encodeId=4e449e666043, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a272265480, createdName=12192b1am98暂无昵称, createdTime=Fri Jun 25 00:01:11 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988274, encodeId=572719882e48d, content=<a href='/topic/show?id=327e563967e' target=_blank style='color:#2F92EE;'>#指南更新#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56396, encryptionId=327e563967e, topicName=指南更新)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04ce158, createdName=lxg951, createdTime=Tue Oct 12 15:34:14 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344340, encodeId=603513443408a, content=<a href='/topic/show?id=683a88964b0' target=_blank style='color:#2F92EE;'>#血压管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88964, encryptionId=683a88964b0, topicName=血压管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=793a2500200, createdName=12498e5fm12(暂无昵称), createdTime=Sat Feb 27 03:34:14 CST 2021, time=2021-02-27, status=1, ipAttribution=)]
    2021-07-15 大叔默默路过

    非常实用。。

    0

  8. 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09:11:30 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999660, encodeId=5e6d999660ee, content=非常实用。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210427/b594a756d77e4171b5313e531ef89b43/31c000a8a97d4872b698c80fb8a33369.jpg, createdBy=624b2152505, createdName=大叔默默路过, createdTime=Thu Jul 15 08:57:42 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976660, encodeId=4e449e666043, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1a272265480, createdName=12192b1am98暂无昵称, createdTime=Fri Jun 25 00:01:11 CST 2021, time=2021-06-25, status=1, ipAttribution=), 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createdName=12498e5fm12(暂无昵称), createdTime=Sat Feb 27 03:34:14 CST 2021, time=2021-02-27, status=1, ipAttribution=)]
    2021-06-25 12192b1am98暂无昵称

    学习了

    0

  9. 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createdName=12498e5fm12(暂无昵称), createdTime=Sat Feb 27 03:34:14 CST 2021, time=2021-02-27, status=1, ipAttribution=)]
  10. 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