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Topic review : Chronic Kidney Disease

Topic review : Chronic Kidney Disease. 鄭昌錡 阮國彰 報告 田亞中主任 指導 2012-4-25. Outline. CKD prevention overview CKD prevention in Linkou CGMH 2006-2010 2011-2012 CKD and Uric acid CKD and CVA. CKD prevention overview. 1. High Incidence and Prevalence of ESRD in Taiwan.

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Topic review : Chronic Kidney Disease

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  1. Topic review :Chronic Kidney Disease 鄭昌錡 阮國彰 報告 田亞中主任 指導 2012-4-25

  2. Outline • CKD prevention overview • CKD prevention in Linkou CGMH • 2006-2010 • 2011-2012 • CKD and Uric acid • CKD and CVA

  3. CKD prevention overview

  4. 1.High Incidence and Prevalence of ESRD in Taiwan Incidence of ESRD,(pmp) Prevalence of ESRD,(pmp) --USRDS, ADR, 2009

  5. 2.High Prevalence of CKD in Taiwan 0.1% CKD stage V 0.2% CKD stage IV 6.8% (3a:6.0%, 3b:0.8%) CKD stage III 3.8% CKD stage II CKD stage I 1.0% Totally 11.9%, About 2 million CKD patients in Taiwan Wen CP et al. Lancet, 2008

  6. 台灣CKD防治計畫的推展 2001 腎臟醫學會於衛生署慢性病委員會 會議提議 2002 國民健康局開始投入先導計畫「腎 臟科門診衛教試辦計劃—工具建立」 2003 腎臟醫學會成立CKD防治委員會， 規範「台灣地區腎臟疾病診療指引建構計劃－台灣血液透析作業與診療指引」 ， 執行「腎臟保健先驅計畫」 2004執行國民健康局「腎臟病保健推廣 機構設置計畫」。 2006 執行國民健康局「推動腎臟保健推廣機構運作及輔導計畫」、「研製慢性腎臟病防治手冊計畫」。 2007 執行國民健康局「96年世界腎臟日宣導計畫」 、「腎臟病健康促進機構運作及輔導計畫」。 • 執行國民健康局「腎臟病健康促進機 • 構推展計畫」、Pre-ESRD整體照護計 • 畫 • 2008 健康局、生策會慢性腎臟病防治科技研究計畫 • 2011 健保局初期慢性腎臟病(early CKD)醫療給付改善方案計畫

  7. CKD試辦計劃 「Pre-ESRD預防性計畫與病人衛教計畫」主要係針對確診為腎臟病之CKD後期(3b、4、5)病患設計，為進一步將潛在病患納入管理，需向CKD初期(1、2、3a)延伸，故100年開辦「初期慢性腎臟病醫療給付改善方案」，俾使慢性腎臟病照護更為完整。

  8. CKD 各分期的治療策略

  9. CKD收費標準及注意事項

  10. Incidence of ESRD,(pmp)USRDS 2010 發生率 Prevalence of ESRD,(pmp)USRDS 2010 盛行率 發生率連續三年下降 盛行率成長已較緩和 USRDS, 2010 ADR

  11. CKD prevention in Linkou CGMH

  12. CKD data from 2006-2010

  13. CKD data from 2010-2011

  14. Early-CKD (2011-2012/3)

  15. CKD 病患照護品質(100年度)

  16. Summary of our CKD data from 2006-2010/3 • Total 2176, Age 59±15,(5-96) • 本院開始CKD治療時間: from 1985/7/1

  17. CKD 病患來源(1)

  18. CKD病患來源(2)

  19. CKD病患來源(3)

  20. CKD病患來源(4)

  21. CKD病患之藥物史與個人史

  22. CKD病患之Underlying disease

  23. CKD病患的家族史

  24. CKD病患之罹病危險因子

  25. 原發疾病大類

  26. 原發疾病次分類

  27. 原發疾病次分類

  28. Data Analysis(1) • Total 1973, f/u duration: 256 ± 270 days,

  29. Data analysis (2) CKD stage Changing

  30. Data Analysis(3) The risk factors of eGFR reducing f/u > 365 days, totally 615 patients P > 0.05 in age, A1c, UA, lipid, Alb, UP, HTN, DM, NSAID, herb, heart dz, CVA, cirrhosis, smoking, drinking…

  31. Data Analysis(4) The correlation between Uric acid and CKD progression

  32. Data Analysis(5)尿酸與年eGFR變化量之關係 Uric acid serum level (mg/dl)

  33. Data Analysis(6)尿酸的變化與年eGFR變化量之關係 Uric acid 變化量 (mg/dl)

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