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Defining Optimal Care of CKD : ( CV Risk management … … )

Quality Wins. NTUH. Defining Optimal Care of CKD : ( CV Risk management … … ). 洪冠予醫師 2009/10/18. Q1 . What’s the Mission of this talk ? … …. 孟子 見 梁惠王 : 王 : 『 叟，不遠千里而來，亦將有以利吾國乎 ?』 孟子 : 『 王何必曰利，亦有仁義而已矣。 』. (n=2,434, CAD 18.9%).

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Defining Optimal Care of CKD : ( CV Risk management … … )

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  1. Quality Wins NTUH Defining Optimal Care of CKD: (CV Risk management……) 洪冠予醫師 2009/10/18

  2. Q1.What’s the Mission of this talk ?… … 孟子見梁惠王: 王: 『叟，不遠千里而來，亦將有以利吾國乎?』 孟子: 『王何必曰利，亦有仁義而已矣。』

  3. (n=2,434, CAD 18.9%)

  4. DM, HT, and Hyperlipidemia associated with increased CKD risk Kuo HW et al. AJKD, 49:46-55, 2007 AVD : Athrosclerotic vascular disease Adjusted for age, sex, region, coronary artery disease, cerebrovascular accident, transient ischemic attack, and peripheral vascular disease

  5. All-cause mortality attributable to CKD:a prospective cohort study (462,293 adults) in Taiwan (Lancet. 2008 Jun 28;371(9631):2173-82)

  6. Mortality Risks for All Causes and CV Diseases and Reduced GFR in a Middle-aged Working Population in Taiwan(AJKD 2008 Aug 14. [Epub ahead of print])

  7. 標竿學習…… 腎臟病防治的重點是什麼 ? Q2.貴院的CKD 衛教計畫，重點項目為: # Who ? # What ? # When ? # How ?

  8. Kidney protection: a key target in the management of patients with diabetes (J Hypertens 2009 May;27(suppl 1):S15–S18) Microalbuminuria LVH arteriopathy Overt CVD, Advanced CKD, or both.

  9. 【 RAADual Blockade for Cardiorenal Protection: An Update 】 Am J Kidney Dis 2009 Feb; 332-345

  10. Am J Med (2008 Apr);121: 265-71

  11. Renin Concentration (PRC) vsRenin Activity (PRA) Am J Med (2008 Apr);121: 265-71

  12. By what standard ? 標竿學習…… Q3.貴院CKD病人CVD現況與醫療計畫為何? # 1 # 2

  13. Kidney protection: a key target in the management of patients with diabetes (J Hypertens 2009 May;27(suppl 1):S15–S18)

  14. 糖尿病腎病變的整合照顧 (NEJM 2002,April 11)

  15. (AURORA, NEJM 2009;360:1395-407)

  16. [NEJM 2009; 360:1455-7] [AJKD 2009; 53(5):723-5] Q4. Is Statinbeneficial for CKD?

  17. Staging of CKD BMJ 2006; 333: 733-7

  18. Mortality Risks for All Causes and CV Diseases and Reduced GFR in a Middle-aged Working Population in Taiwan(AJKD 2008 Aug 14. [Epub ahead of print])

  19. (Am J Cardiol 2008;102:1668 –73) (GFR <60 /min) (GFR <50 /min)

  20. Q5.結構面: Def. of Critical CKD Stage ?

  21. Kidney Dysfunction as a CV Risk Factor Arch Intern Med 2008;168(6):617-624

  22. Q6. From CKD to CVD: same mechanism? Traditional Risk Factors CV risk Oxidative Stress Inflammation Insulin resistance (metabolic syndrome)

  23. Insulin Resistance, Adiponectin and Chronic Inflammation in Dialysis (HD & PD) Patients (Huang JW, Hung KY, et al. AJKD 2004;43:1047-55)

  24. [Chiang CK, et al. Am J Nephrol 2009;29:392-397]

  25. Implications of the Jupiter Trial ? [NEJM 2008; 359:2195-2207]

  26. (Hung KY, et al. Eur J Endocrin 2009;160:1-9) Fetuin-A, insulin resistance in non-diabetic HD Patients Chronic inflammation, Insulin resistance in DM HD Patients (Hung KY, et al. Diabetes Care 2007;30:3-7)

  27. Q7.Will you prescribe Cardio-protective agents for your CKD patients ? • Yes, always • Often • Seldom • No, never

  28. Q8.Risk management: “Frequency and items of measurement” ?

  29. Q9.FromCKD toCVD: mechanism ? Oxidative Stress Inflammation Insulin Resistance Traditional Risk Factors CV risk JASN 2008;19:1065–70

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