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        近期提問
        大夫你好,倍他樂克我早晚各吃25毫克,心跳有時五十多下。這個藥可以停了嗎? 2019-09-21
        張益民 中山大學附屬第六醫院
        可以減量,但不一下停,停了之后會帶來更嚴重的后果[詳情]
        回回都有氣泡,老病人懷疑是管不合格,對身體有害嗎,謝謝了透析機時間長了會影響排毒嗎 2019-09-16
        宋金輝 南京婦幼保健院北院
        您是用長期導管還是用瘺的呀?有氣泡可能是血管通路流量不夠,時間長了有可能影響透析充分性[詳情]
        營養學院您身邊的營養專家
        醫生專區專業及時,為您量身定制
        2017ISPD建議導管相關感染
        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關于慢性腎臟病-礦物質和骨異常?CKD-MBD臨床實踐指南的解讀
        慢性腎臟病-礦物質和骨異常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的防治是慢性腎臟病(chronic kidney disease,CKD)患者減少心血管疾病風險策略中的重要組成部分。 早在 20 世紀 30 年代,中國學者首次提出了腎性骨病(腎性骨營養不良)的概念。作為腎性骨病的延伸,CKD-MBD 的定義誕生于 2005 年馬德里舉 行的第一次 CKD-MBD 討論會上。改善全球腎臟病預后組織(kidney disease:improving global outcomes,KDIGO)于 2009 年頒布了適用于全球的CKD-MBD 的診斷、評估、預防和治療的臨床實踐指南[1]。2013 年后,專家多次開會,對指南中的骨病、鈣磷、維生素 D、PTH 水平和血管鈣化這些熱點進行討論和指南評估/更新的準備。2016 年新指南草案公布,在全球范圍內廣泛征集意見,并于2017 年 6 月正式對外頒布[2](其下載網址見表 1)。新指南中,12 項推薦被重新評估,而大部分 2009年的指南內容未變。新增推薦的證據主要來自于2 0 0 9 年后至 2 0 1 7 年 2 月數項隨機對照試驗(randomized controlled clinical trial,RCT)和 Meta分析結果。本文就 2017 版的新指南與舊版指南的更新部分及依然存在的、值得進一步研究的熱點問題進行解讀
        2017+NICE診斷指南?多頻生物電阻抗裝置指導慢性腎病患者進行血液透析時的液體管理?
        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.
        中國腎臟疾病高尿酸血癥診治的實踐指南?2017版
        隨著我國人民生活水平提高和生活方式改變,高尿酸血癥的患病率呈逐年上升趨勢,已經成為我國重要的公共衛生問題.腎臟疾病是高尿酸血癥的重要病因,而高尿酸血癥也是慢性腎臟病(chronic kidney disease,CKD)最常見的并發癥之一.高尿酸血癥可加重腎臟病的進展和心腦血管并發癥的發生,是導致CKD、心腦血管疾病和代謝性疾病發生與發展的獨立危險因素.目前我國尚缺乏針對腎臟疾病高尿酸血癥診治的臨床實踐指南.為此,我們圍繞腎臟疾病高尿酸血癥的流行病學、發病機制、診斷與病情評估、治療等內容,制定《中國腎臟疾病高尿酸血癥診治的實踐指南(2017版)》,以指導臨床更規范地治療腎臟疾病患者的高尿酸血癥。
        中華人民共和國衛生行業標準-慢性腎臟病患者膳食指導?
        慢性腎臟病患者膳食指導 1 范圍 本標準規定了慢性腎臟病患者膳食指導原則、能量和營養素推薦攝入量、膳食處方的制定、營養攝入監測與評估。 本標準適用于對慢性腎臟病患者進行膳食指導。 2 術語和定義 下列術語和定義適用于本文件。 2.1 慢性腎臟病 chronic kidney disease;CKD 經腎活檢或檢測腎損傷標志物證實的腎臟損傷或GFR持續<60 mL/(min·1.73m2)≥3個月。腎損傷的指標陽性包括血、尿成分異常或影像學檢查異常。 2.2 慢性腎臟病分期 stage of CKD CKD按照GFR值進行分期,見表1。
        2017+ERA-EDTA?E共識文件透析患者高血壓
        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


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