Gorostidi Manuel, Santamaría Rafael, Alcázar Roberto, Fernández-Fresnedo Gema, Galcerán Josep M, Goicoechea Marián, Oliveras Anna, Portolés José, Rubio Esther, Segura Julián, Aranda Pedro, de Francisco Angel L M, Del Pino M Dolores, Fernández-Vega Francisco, Górriz José L, Luño José, Marín Rafael, Martínez Isabel, Martínez-Castelao Alberto, Orte Luis M, Quereda Carlos, Rodríguez-Pérez José C, Rodríguez Mariano, Ruilope Luis M
Nefrologia. 2014 May 21;34(3):302-16. doi: 10.3265/Nefrologia.pre2014.Feb.12464. Epub 2014 Mar 6.
The new Kidney Disease: Improving Global Outcomes (KDIGO) international guidelines on chronic kidney disease (CKD) and the management of blood pressure (BP) in CKD patients are an update of the corresponding 2002 and 2004 KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines. The documents aim to provide updated guidelines on the assessment, management and treatment of patients with CKD. The first guidelines retain the 2002 definition of CKD but present an improved prognosis classification. Furthermore, concepts about prognosis of CKD, recommendations for management of patients, and criteria for referral to the nephrologist have been updated. The second guideline retains the <130/80 mm Hg-goal for management of BP in patients with CKD presenting increased albuminuria or proteinuria (albumin-to-creatinine ratio 30-300 mg/g, and >300 mg/g, respectively) but recommends a less-strict goal of <140/90 mm Hg in patients with normoalbuminuria. The development of the guidelines followed a predetermined process in which the evidence available was reviewed and assessed. Recommendations on management and treatment are based on the systematic review of relevant studies. The GRADE system (Grading of Recommendations Assessment, Development and Evaluation) was used to assess the quality of evidence and issue the grade of recommendation. Areas of uncertainty are also discussed for the different aspects addressed.
新版《肾脏病:改善全球预后》(KDIGO)慢性肾脏病(CKD)及CKD患者血压管理国际指南是对2002年和2004年美国肾脏病基金会肾脏病预后质量倡议(KDOQI)相应指南的更新。这些文件旨在提供关于CKD患者评估、管理和治疗的最新指南。第一部指南保留了2002年CKD的定义,但给出了改进后的预后分类。此外,关于CKD预后的概念、患者管理建议以及转诊至肾病科医生的标准均已更新。第二部指南对于白蛋白尿或蛋白尿增加(白蛋白与肌酐比值分别为30 - 300 mg/g和>300 mg/g)的CKD患者,保留了血压管理<130/80 mmHg的目标,但对于尿白蛋白正常的患者,建议采用<140/90 mmHg这一相对宽松的目标。指南的制定遵循了预定流程,在此过程中对现有证据进行了审查和评估。管理和治疗建议基于对相关研究的系统评价。采用推荐分级的评估、制定和评价(GRADE)系统来评估证据质量并给出推荐等级。针对所涉及的不同方面,还讨论了存在不确定性的领域。