Am J Kidney Dis. 2012 Nov;60(5):850-86. doi: 10.1053/j.ajkd.2012.07.005.
The 2012 update of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Diabetes and Chronic Kidney Disease (CKD) is intended to assist the practitioner caring for patients with diabetes and CKD. Substantial high-quality new evidence has emerged since the original 2007 KDOQI guideline that could significantly change recommendations for clinical practice. As such, revisions of prior guidelines are offered that specifically address hemoglobin A(1c) (HbA(1c)) targets, treatments to lower low-density lipoprotein cholesterol (LDL-C) levels, and use of angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) treatment in diabetic patients with and without albuminuria. Treatment approaches are addressed in each section and the stated guideline recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Limitations of the evidence are discussed and specific suggestions are provided for future research.
2012 年版《肾脏病预后质量倡议(KDOQI)糖尿病和慢性肾脏病(CKD)临床实践指南》更新版旨在为治疗糖尿病合并 CKD 患者的临床医生提供帮助。自最初的 2007 年 KDOQI 指南发布以来,出现了大量高质量的新证据,这些证据可能会显著改变临床实践建议。因此,提供了对先前指南的修订,特别是针对血红蛋白 A1c(HbA1c)目标、降低低密度脂蛋白胆固醇(LDL-C)水平的治疗以及在有或无白蛋白尿的糖尿病患者中使用血管紧张素转换酶抑制剂(ACE-I)和血管紧张素受体阻滞剂(ARB)的治疗。在每个部分中都讨论了治疗方法,并根据相关试验的系统评价提出了既定的指南建议。对证据质量和建议强度的评估遵循了推荐评估、制定与评价(GRADE)方法。讨论了证据的局限性,并为未来的研究提供了具体建议。