慢性肾脏病患者的血脂管理.pptx

1、慢性肾脏病患者的血脂管理,1,a,background,Dyslipidemia, defined as increased levels of serum cholesterol and/or triglycerides, is a well-established traditional risk factor for atherosclerotic CAD in the general population and in patients with mild-tomoderate CKD, particularly those with nephroticrange proteinuri

2、a,2,a,Lists the various lipid abnormalities in nondialyzed CKD patients and dialysis patients,3,a,CONVERSION FACTORS OF CONVENTIONAL UNITS TO SI UNITS,4,a,慢性肾脏病非透析患者,5,a,2013ACC/AHA血脂指南推荐,新指南的最大变化为取消了低密度脂蛋白胆固醇（LDL-C）和非高密度脂蛋白胆固醇（HDL-C）的推荐目标，即对合并有心血管疾病的患者不再推荐LDL-C低于 100 mg/dL、70 mg/dL的达标值和理想值,6,a,2013

3、ACC/AHA血脂指南推荐,由于缺乏来自于随机对照试验的证据，更新指南不再对动脉粥样硬化性心血管疾病的一级和二级预防推荐LDL-C或非HDL-C特定目标。为使LDL-C水平相对降低，新指南确定了适当他汀类药物治疗的四组一级和二级预防患者，并要求临床医生专注于减少此类患者的心血管疾病事件,7,a,8,a,9,a,KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease (CKD) patients,10,a,KDIGO 临床实践指南 慢性肾脏病患者的血脂管理,对新确诊的成人CKD患者(包括长期

4、透析治疗和肾移植的患者)，推荐评价血脂谱(总胆固醇、低密度脂蛋白、高密度脂蛋白和甘油三酯)。(1C) 大部分成人CKD患者(包括长期透析治疗和肾移植的患者)不需要监测血脂水平。(未分级,Kidney International Supplements (2013) 3, 263265,11,a,对于年龄50 岁，eGFR60mL/min/1.73m2 且未开始长期透析或接受肾移植的CKD 患者(GFR 分期 G3a-G5)，推荐他汀类或他汀类/依择麦布联合制剂。(1A) 对于年龄50 岁，eGFR 60mL/min/1.73m2 的CKD患者(GFR分期 G1-G2)，推荐使用他汀类药物。(1

5、B) 对于年龄在18-49岁且未开始长期透析或接受肾移植的CKD患者，建议在出现以下一种或多种情况时使用他汀类药物(2A): 既有的冠脉疾病(心肌梗死或冠脉血管再通术) 糖尿病 既往缺血性脑卒中史 预计10年内因冠脉病变致死或发生非致死性心肌梗死的风险超过10,KDIGO 临床实践指南 慢性肾脏病患者的血脂管理,Kidney International Supplements (2013) 3, 263265,12,a,在透析依赖的成人CKD患者中,不建议他汀类或他汀类/依择麦布联合制剂的治疗。(2A) 如果开始透析时患者已经在服用他汀类或他汀类/依择麦布联合制剂,则建议继续使用。(2C) 对

6、于成人肾移植受者,建议使用他汀类药物。(2B,KDIGO 临床实践指南 慢性肾脏病患者的血脂管理,Kidney International Supplements (2013) 3, 263265,13,a,Chapter 5: Triglyceride-lowering treatment in adults,In adults with CKD (including those treated with chronic dialysis or kidney transplantation) and hypertriglyceridemia, we suggest that therapeu

7、tic lifestyle changes be advised. (2D,Kidney International Supplements (2013) 3, 263265,14,a,慢性肾脏病透析患者,15,a,Comparison of the three major randomized controlled trials: 4D, AURORA and SHARP,16,a,为什么调脂治疗在透析患者中效果差,First, the pathophysiology and spectrum of CVD in dialysis patients is markedly different

8、 compared to that in the general population or even to earlier stages of CKD Besides atherosclerosis, these patients may develop arterial stiffness, vascular calcification, left ventricular hypertrophy, left ventricular diastolic dysfunction, congestive cardiomyopathy, and sudden cardiac death from arrhythmia,17,a,为什么调脂治疗在透析患者中效果差,18,a