KDIGOAKI诊疗指南解读
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– KDIGO Clinical Practice Guideline for Acute Kidney Injury
KDIGO,2012
AKI流行病学现状
• • • • • • 患病率：1%（社区）~ 7.1%（医院） 人群发病率：486~630 pmp/y AKI需要RRT发病率：22~203pmp/y 医院获得AKI死亡率：10~80% 合并多脏器功能衰竭死亡率：>50% 需要RRT治疗者死亡率：高达80%
KDIGO,2012
Chapter 2.2: Risk assessment
KDIGO,2012
Chapter 2.2: Risk assessment
KDIGO,2012
Definition and staging of AKI
AKI is defined as any of the following (Not Graded ):
KDIGO,2012
ConceptualModel model for Conceptual forAKI AKI
Stages defined by creatinine and urine output are surrogates Complications Complications
GFR
Normal Normal Increased Increased risk risk Damage Damage GFR GFR Kidney Kidney failure failure Death Death
KDIGO：Kidney Disease Improving Global Outcomes
急性肾损伤诊疗指南解读
KDIGO Clinical Practice Guideline for Acute Kidney Injury,2012
2012-KDIGO指南解读
赵良斌
KDIGO,2012
急性肾损伤(AKI)与急性肾衰竭(ARF)
单用尿量改变作为判断标准时，需要除外尿路梗阻及其它导致尿量减少的原因
KDIGO,2012
AKI分期标准
指南推荐血清肌酐和尿量仍然作为AKI最好的标志物(1B)
KDIGO,2012
ห้องสมุดไป่ตู้IFLE分级
2002 年急性透析质量倡议组(ADQI)制定了ARF的 RIFLE 分级诊断标准。
Bellomo R, et al. Crit Care 2004;8:R204-R212
Damage
Antecedents Intermediate Stage AKI Outcomes Markers such as NGAL, KIM-1, and IL-18 are surrogates
KDIGO,2012
Guideline 2：临床评估
2.1 详细的病史采集和体格检查有助于 AKI病因的 判断(1A) 2.2 24小时之内进行基本的检查，包括尿液分析和 泌尿系超声(怀疑有尿路梗阻者)(1A)
KDIGO,2012
指南推荐强度
Quality of evidence
A－High B－ Moderate
Strength of recommendatio n
Level1－strong Level2－weak or discretionary
C－Low
D－Very low
KDIGO,2012
指南推荐强度
KDIGO,2012
Guideline 1：AKI的定义与分期
采用KDIGO推荐的定义和分期标准 符合以下情况之一者即可被诊断为AKI：
① 48小时内Scr升高超过26.5μmol/L(0.3 mg/dl)； ② Scr 升高超过基线1.5倍—确认或推测7天内发生； ③ 尿量＜0.5 ml/（kg· h），且持续6小时以上。
About AKI guideline
• ADQI：2002, RIFLE • AKIN：2005, modified definition and staging system • KDIGO: 2011, First clinical guideline for AKI – Waiting for published in this summer • AKI guideline for AKI :2011 – UK Renal Association Final Version 08.03.11 • AKI guidline—KDIGO 2012
presumed to have occurred withinthe prior 7 days;
· orKUrine volume o0.5 ml/kg/h for 6 hours.
Test patients at increased risk for AKI with measurements of SCr and urine output to detect AKI. ( Not Graded ) Individualize frequency and duration of monitoring based on patient risk and clinical course. ( Not Graded ) Evaluate patients with AKI promptly to determine the cause, with special attention to reversible causes.(Not Graded ) he cause of AKI should be determined whenever possible. (Not Graded)
●
国际肾脏病和急救医学界将ARF 改为急性肾损伤 （Acute Kidney Injury, AKI）。
GFR正常伴肾脏损伤的标志物改变
●
AKI 覆盖的肾损伤 GFR开始下降
GFR明显异常
Warnock DG. J Am Soc Nephrol 16:3149-3150,2006 Biesen WV et al. CJASN. 2006 KDIGO,2012
· AKI is defined as any of the following (Not Graded ):
KIncrease in SCr by X 0.3 mg/dl ( X26.5 lmol/l)within 48 hours;
· or KIncrease in SCr to X1.5 times baseline, whichis known or
KDIGO,2012
AKI流行病学现状
• • • • • • 患病率：1%（社区）~ 7.1%（医院） 人群发病率：486~630 pmp/y AKI需要RRT发病率：22~203pmp/y 医院获得AKI死亡率：10~80% 合并多脏器功能衰竭死亡率：>50% 需要RRT治疗者死亡率：高达80%
KDIGO,2012
Chapter 2.2: Risk assessment
KDIGO,2012
Chapter 2.2: Risk assessment
KDIGO,2012
Definition and staging of AKI
AKI is defined as any of the following (Not Graded ):
KDIGO,2012
ConceptualModel model for Conceptual forAKI AKI
Stages defined by creatinine and urine output are surrogates Complications Complications
GFR
Normal Normal Increased Increased risk risk Damage Damage GFR GFR Kidney Kidney failure failure Death Death
KDIGO：Kidney Disease Improving Global Outcomes
急性肾损伤诊疗指南解读
KDIGO Clinical Practice Guideline for Acute Kidney Injury,2012
2012-KDIGO指南解读
赵良斌
KDIGO,2012
急性肾损伤(AKI)与急性肾衰竭(ARF)
单用尿量改变作为判断标准时，需要除外尿路梗阻及其它导致尿量减少的原因
KDIGO,2012
AKI分期标准
指南推荐血清肌酐和尿量仍然作为AKI最好的标志物(1B)
KDIGO,2012
ห้องสมุดไป่ตู้IFLE分级
2002 年急性透析质量倡议组(ADQI)制定了ARF的 RIFLE 分级诊断标准。
Bellomo R, et al. Crit Care 2004;8:R204-R212
Damage
Antecedents Intermediate Stage AKI Outcomes Markers such as NGAL, KIM-1, and IL-18 are surrogates
KDIGO,2012
Guideline 2：临床评估
2.1 详细的病史采集和体格检查有助于 AKI病因的 判断(1A) 2.2 24小时之内进行基本的检查，包括尿液分析和 泌尿系超声(怀疑有尿路梗阻者)(1A)
KDIGO,2012
指南推荐强度
Quality of evidence
A－High B－ Moderate
Strength of recommendatio n
Level1－strong Level2－weak or discretionary
C－Low
D－Very low
KDIGO,2012
指南推荐强度
KDIGO,2012
Guideline 1：AKI的定义与分期
采用KDIGO推荐的定义和分期标准 符合以下情况之一者即可被诊断为AKI：
① 48小时内Scr升高超过26.5μmol/L(0.3 mg/dl)； ② Scr 升高超过基线1.5倍—确认或推测7天内发生； ③ 尿量＜0.5 ml/（kg· h），且持续6小时以上。
About AKI guideline
• ADQI：2002, RIFLE • AKIN：2005, modified definition and staging system • KDIGO: 2011, First clinical guideline for AKI – Waiting for published in this summer • AKI guideline for AKI :2011 – UK Renal Association Final Version 08.03.11 • AKI guidline—KDIGO 2012
presumed to have occurred withinthe prior 7 days;
· orKUrine volume o0.5 ml/kg/h for 6 hours.
Test patients at increased risk for AKI with measurements of SCr and urine output to detect AKI. ( Not Graded ) Individualize frequency and duration of monitoring based on patient risk and clinical course. ( Not Graded ) Evaluate patients with AKI promptly to determine the cause, with special attention to reversible causes.(Not Graded ) he cause of AKI should be determined whenever possible. (Not Graded)
●
国际肾脏病和急救医学界将ARF 改为急性肾损伤 （Acute Kidney Injury, AKI）。
GFR正常伴肾脏损伤的标志物改变
●
AKI 覆盖的肾损伤 GFR开始下降
GFR明显异常
Warnock DG. J Am Soc Nephrol 16:3149-3150,2006 Biesen WV et al. CJASN. 2006 KDIGO,2012
· AKI is defined as any of the following (Not Graded ):
KIncrease in SCr by X 0.3 mg/dl ( X26.5 lmol/l)within 48 hours;
· or KIncrease in SCr to X1.5 times baseline, whichis known or