臨床醫療與公共衛生的挑戰 - doctor.org.tw

1 332 JOURNAL OF KAOHSIUNG MEDICAL ASSOCIATION 2010. , End-Stage Renal Diseases, ESRD International Society of Nephrology, ISN United States Renal Data System, USRDS, 2005 2004 ESRD 2288 2060 1698 415 372 361 285 [1] 2000 Chronic Kidney Diseases, CKD [2] 1 2 GFR 60ml/ mg/dl 1 1,2 1.

2 2. 333 inulin 99mTc-DTPA 125I-iothalamate 24 Creatinine clearance Cockcroft Gault [3] 1976 236 (Cockcroft DW and Gault MH) 140- / 72 ( ) 1999 Levey AS Modification of Diet in Renal Disease MDRD 6 MDRD Simplified MDRD [4] ( ) ( ) eGFR MDRD eGFR ( ) CKD 1 Urine albumin creatinine ratio UACR 30mg/gm 300mg/gm GFR ml/ 1 GFR 90 UACR 30mg/g2 GFR 60-89 UACR 30mg/g3 30-594 15-295 15 K/DOQI 2002 334 JOURNAL OF KAOHSIUNG MEDICAL ASSOCIATION 2010.

3 , Mircroalbuminuria 300mg/gm Marcroalbuminuria Overt proteinuria Urine protein creatinine ratio UPCR 200mg/gl CKD CKD ? CKD CKD-- CKD CKD [5] 46 CKD 10 1 CKD CKD CKD CKD CKD CKD CKD 8% 25% [6] CKD CKD CKD CKD ( )

4 CKD CKD CKD 335 (eGFR<60 mL/ ) NSAID CKD CKD 1. US Renal Data System. USRDS 2009 Annual Data Report. The national Institutes of health, national institutes of Diabetes and Digestive and Kidney Disease, Bethesda, MD, 2009. Avail-able at: Ac-cessed Aug 2, 20102. National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classifica-tion, and stratification.

5 Am J Kidney Dis 2002; 39(2 Suppl 1): Cockcroft, and Gault: Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16(1): Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: Wen CP, Cheng TY, Tsai MK, et al. All-cause mortality attributable to chro-nic kidney disease: a prospective co-hort study based on 462 293 adults in Taiwan. Lancet 2008; 371: 2173-21826. Hsu CC, Hwang SJ, Wen CP, et al.: High prevalence and low awareness of CKD in Taiwan: a study on the rela-tionship between serum creatinine and awareness from a nationally represen-tative survey.

6 Am J Kidney Dis 2006; 48(5): 727-38.