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大夫你好,倍他乐克我早晚各吃25毫克,心跳有时五十多下。这个药可以停了吗? 2019-09-21
张益民 中山大学附属第六医院
可以减量,但不一下停,停了之后会带来更严重的后果[详情]
回回都有气泡,老病人怀疑是管不合格,对身体有害吗,谢谢了透析机时间长了会影响排毒吗 2019-09-16
宋金辉 南京妇幼保健院北院
您是用长期导管还是用瘘的呀?有气泡可能是血管通路流量不够,时间长了有可能影响透析充分性[详情]
营养学院您身边的营养专家
医生专区专业及时,为您量身定制
中国肾脏疾病高尿酸血症诊治的实践指南ˆ2017版
随着我国人民生活水平提高和生活方式改变,高尿酸血症的患病率呈逐年上升趋势,已经成为我国重要的公共卫生问题.肾脏疾病是高尿酸血症的重要病因,而高尿酸血症也是慢性肾脏病(chronic kidney disease,CKD)最常见的并发症之一.高尿酸血症可加重肾脏病的进展和心脑血管并发症的发生,是导致CKD、心脑血管疾病和代谢性疾病发生与发展的独立危险因素.目前我国尚缺乏针对肾脏疾病高尿酸血症诊治的临床实践指南.为此,我们围绕肾脏疾病高尿酸血症的流行病学、发病机制、诊断与病情评估、治疗等内容,制定《中国肾脏疾病高尿酸血症诊治的实践指南(2017版)》,以指导临床更规范地治疗肾脏疾病患者的高尿酸血症。
2017+ERA-EDTAE共识文件透析患者高血压
In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin–angiotensin–aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient’s comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the
中华人民共和国卫生行业标准-慢性肾脏病患者膳食指导‰
慢性肾脏病患者膳食指导 1 范围 本标准规定了慢性肾脏病患者膳食指导原则、能量和营养素推荐摄入量、膳食处方的制定、营养摄入监测与评估。 本标准适用于对慢性肾脏病患者进行膳食指导。 2 术语和定义 下列术语和定义适用于本文件。 2.1 慢性肾脏病 chronic kidney disease;CKD 经肾活检或检测肾损伤标志物证实的肾脏损伤或GFR持续<60 mL/(min·1.73m²)≥3个月。肾损伤的指标阳性包括血、尿成分异常或影像学检查异常。 2.2 慢性肾脏病分期 stage of CKD CKD按照GFR值进行分期,见表1。
2017ISPD建议导管相关感染
Peritoneal dialysis (PD) catheter-related infections are a major predisposing factor to PD-related peritonitis (1–3). The primary objective of preventing and treating catheter-related infections is to prevent peritonitis. Recommendations on the prevention and treatment of catheter-related infections were published previously together with recommendations on PD peritonitis under the auspices of the International Society for Peritoneal Dialysis (ISPD) in 1983 and revised in 1989, 1993, 1996, 2000, 2005, and 2010 (4–9). The present recommendations, however, focus on catheter-related infections, while peritonitis will be covered in a separate guideline. These recommendations are evidence-based where such evidence exists. The bibliography is not intended to be comprehensive. When there are many similar reports on the same area, the committee prefers to refer to the more recent publications. In general, these recommendations follow the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system for classification of the level of evidence and grade of recommendations in clinical guideline reports (10). Within each recommendation, the strength of recommendation is indicated as Level 1 (We recommend), Level2 (We suggest), or Not Graded, and the quality of the supporting evidence is shown as A (high quality), B (moderate quality), C (low quality), or D (very low quality). The recommendations are not meant to be implemented in every situation indiscriminately. Each PD unit should examine its own pattern of infection, causative organisms, and sensitivities and adapt the protocols according to local conditions as necessary. Although many of the general principles presented here could be applied to pediatric patients, we focus on catheter-related infections in adult patients. Clinicians who take care of pediatric PD patients should refer to the latest consensus guideline in this area for detailed treatment regimen and dosage (11).
2017年KDIGO关于慢性肾脏病-矿物质和骨异常ˆCKD-MBD临床实践指南的解读
慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的防治是慢性肾脏病(chronic kidney disease,CKD)患者减少心血管疾病风险策略中的重要组成部分。 早在 20 世纪 30 年代,中国学者首次提出了肾性骨病(肾性骨营养不良)的概念。作为肾性骨病的延伸,CKD-MBD 的定义诞生于 2005 年马德里举 行的第一次 CKD-MBD 讨论会上。改善全球肾脏病预后组织(kidney disease:improving global outcomes,KDIGO)于 2009 年颁布了适用于全球的CKD-MBD 的诊断、评估、预防和治疗的临床实践指南[1]。2013 年后,专家多次开会,对指南中的骨病、钙磷、维生素 D、PTH 水平和血管钙化这些热点进行讨论和指南评估/更新的准备。2016 年新指南草案公布,在全球范围内广泛征集意见,并于2017 年 6 月正式对外颁布[2](其下载网址见表 1)。新指南中,12 项推荐被重新评估,而大部分 2009年的指南内容未变。新增推荐的证据主要来自于2 0 0 9 年后至 2 0 1 7 年 2 月数项随机对照试验(randomized controlled clinical trial,RCT)和 Meta分析结果。本文就 2017 版的新指南与旧版指南的更新部分及依然存在的、值得进一步研究的热点问题进行解读
2017+NICE诊断指南š多频生物电阻抗装置指导慢性肾病患者进行血液透析时的液体管理‰
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.


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