2015年欧洲肾脏最佳临床实践关于糖尿病合并慢性肾脏病3b期或更高阶段临床管理指南解读

ERBP interpretation of clinical practice guideline on management of patients with diabetes and chronic kidney disease of stage 3b or higher in 2015

糖尿病和慢性肾脏病(chronic kidney disease,CKD)密切相关。2007年美国肾脏基金会(national kidney foundation,NKF)-肾脏病预后与透析患者生存质量指导工作组(kidney disease:improving global Outcomes,KDOQI)首次制定了关于糖尿病合并CKD的临床实践指南,并于2012年进行了更新,为糖尿病合并CKD患者的诊治提供了循证依据。然而,糖尿病合并CKD 3b期或更高阶段患者的管理仍然存在诸多的不确定性。2015年欧洲肾脏最佳临床实践(European renal best practice,ERBP)基于2014年5月及之前的循证证据制订了糖尿病合并CKD 3b期或更高阶段患者的管理指南,主要针对这类患者肾脏替代治疗方式的选择、血糖的管理及心血管并发症的防治进行了阐述。

Diabetes mellitus is closely related to chronic kindney disease（CKD）. In 2007, National Kidney Foundation（NKF）-Kidney Disease： Improving Global Outcomes（KDIGO） have firstly formulated the clinical practice guideline for the management of patients with diabetes mellitus and CKD, which has been updated in 2012. The guideline provided evidence-based basis for the management of patients with diabetes mellitus and CKD. However, there still is large amount of uncertainty when dealing with patients with diabetes and CKD stage 3b or higher. In 2015, European Renal Best Practice（ERBP） put out the clinical practice guideline on management of patients with diabetes and CKD stage 3b or higher based on the evidence-based basis before May, 2014. The guideline mainly focused on three major areas：（1） selection of renal replacement modality;（2） management of glycaemic control;（3） management and prevention of cardiovascular comorbidity.