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KDIGO 2024 慢性肾脏病评估和管理临床实践指南执行摘要:已知的已知和已知的未知。

Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns.

机构信息

Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

出版信息

Kidney Int. 2024 Apr;105(4):684-701. doi: 10.1016/j.kint.2023.10.016.

Abstract

The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) updates the KDIGO 2012 guideline and has been developed with patient partners, clinicians, and researchers around the world, using robust methodology. This update, based on a substantially broader base of evidence than has previously been available, reflects an exciting time in nephrology. New therapies and strategies have been tested in large and diverse populations that help to inform care; however, this guideline is not intended for people receiving dialysis nor those who have a kidney transplant. The document is sensitive to international considerations, CKD across the lifespan, and discusses special considerations in implementation. The scope includes chapters dedicated to the evaluation and risk assessment of people with CKD, management to delay CKD progression and its complications, medication management and drug stewardship in CKD, and optimal models of CKD care. Treatment approaches and actionable guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence and the strength of recommendations which followed the "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE) approach. The limitations of the evidence are discussed. The guideline also provides practice points, which serve to direct clinical care or activities for which a systematic review was not conducted, and it includes useful infographics and describes an important research agenda for the future. It targets a broad audience of people with CKD and their healthcare, while being mindful of implications for policy and payment.

摘要

《肾脏疾病:改善全球肾脏病预后组织(KDIGO)慢性肾脏病(CKD)评估和管理临床实践指南》更新了 KDIGO 2012 指南,并与世界各地的患者伙伴、临床医生和研究人员一起使用了强有力的方法进行了开发。本更新基于比以往更广泛的证据基础,反映了肾脏病学的一个激动人心的时刻。新的治疗方法和策略已在大型和多样化的人群中进行了测试,有助于指导治疗;然而,本指南不适用于接受透析或接受肾移植的患者。本文件对国际考虑因素、整个生命周期的 CKD 以及实施中的特殊考虑因素都很敏感。范围包括专门用于评估和评估 CKD 患者风险、延迟 CKD 进展及其并发症的管理、CKD 药物管理和药物管理以及 CKD 护理的最佳模式的章节。治疗方法和可操作的指南建议是基于对相关研究的系统评价以及对证据质量和建议强度的评估,遵循“推荐评估、制定和评估”(GRADE)方法。讨论了证据的局限性。该指南还提供了实践要点,旨在指导未进行系统评价的临床护理或活动,包括有用的信息图表,并描述了未来的重要研究议程。它针对广大 CKD 患者及其医疗保健人员,同时考虑到对政策和支付的影响。

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