..

2552
ISBN 974-300-791-0
1

2552
5,000

2 50
3 47
10310
0-2716-6901

()


(Chronic Kidney Disease, CKD)


(End Stage Renal Disease,
ESRD)

12
2552

III

2552

IV

.. 2552

1:

2:
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6:

7:

7
8
9
11
12
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20
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24
25
V

 8:

9:
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17:

2
12 2552
3 (eGFR)
MDRD
4 (eGFR)
MDRD

IV

28
29
30
34
35
36
37
38
39
40
43
44
45
46

.. 2552

Strength of Recommendation

(cost effective)

Quality of Evidence

1.1 (systematic review)
- (randomizecontrolled clinical trial) 1
1.2 -
(a well-designed randomize-controlled clinical
trial) 1

2.1
(non-randomized controlled clinical
trial)
2.2
(well-designed non-randomized controlled
clinical trial)
2.3
(cohort)
(case-control analytical studies)

/

.. 2552

2.4 (multiple time series)

.. 2480

10

3.1 (descriptive studies)
3.2
(fair-designed controlled clinical trial)

4.1
(consensus)

4.2 (case series)

2

(anecdotal report)

1. (screening and consultation

or referral)

2. (slowing the progression of kidney

disease)

3. (evaluation
and treating CKD complications)

4. (cardiovascular risk reduction)

5. (preparation for renal

replacement therapy)

.. 2552

11

1. 3
(glomerular filtration rate, GFR)

1.1 2
3
1.1.1
1.1.1.1
microalbuminuria
1.1.1.2
proteinuria 500 mg
500 mg/g creatinine
1.1.2 (hematuria)
1.2
1.3
2. GFR 60 mL/min/1.73m2
3

12

1
2
3
4
5

GFR (mL/min/1.73m2)

GFR
90
GFR
60 - 89
GFR
30 - 59
GFR
15 - 29

< 15 (
)

.. 2552

13

micro
albuminuria

proteinuria

total
protein

24

< 300 mg

> 300 mg

albumin

(dipstick)

< 200 mg/g

creatinine
protein/
creatinine ratio
24

< 30 mg

(microalbuminuria
dipstick)

< 30 mg/g
creatinine
albumin/
creatinine ratio

> 200 mg/g

creatinine

30-300 mg

> 300 mg

30-300
mg/g
creatinine

> 300 mg/g

creatinine

2.2 ( 18)
14

1.1
(

1)

2)

1.2
(

1.3 (autoimmune diseases)

3)

1.4 (systemic infection)

(

3)

1.5 (cardiovascular disease)

(

3)

1.6
(

.. 2552

3)
15

1.7
(

1.8 60
(

4)
4)

1.9
(

1.10
(

1.11
(

16

4)

4)

4)

1

2.1 estimated GFR (eGFR) 1
(serum creatinine, SCr)
Modification of Diet in Renal Disease (MDRD)
Equation[1]
(

2)

eGFR (mL/min/1.73m2) =
186.3 x SCr (jae) 1.154 x Age 0.203 x (0.742 )

MDRD equation
eGFR Crockcoft-Gault equation
(

4)

[2] 1.73m2
CCr (ml/min) = (140Age) x Body weight x (0.85 )
72 x SCr
[1] racial-factor eGFR
racial-factor 1.016
MDRD
[2] Body surface area (Mosteller formula) = Body weight (kg) x Hight (cm)
3,600

.. 2552

17

2.2
(Dipstick)
2.2.1
2.2.1.1 1+


(

3)

2.2.1.2
urinary albumin/creatinine ratio
(UACR) (spot
morning urine) 30-300 mg/g
microalbuminuria
(

2)

2.2.1.3 UACR
microalbuminuria dipstick

microalbuminuria
(

4)

2.2.2
2.2.2.1 2+

18

2.2.2.2 1+
urinary protein/creatinine ratio
(UPCR) 500 mg/g

3)

2.3
microscopic examination
5/HPF

(

4)

2.4 2.1 - 2.3

3

4)

2.5 (plain KUB) /

(ultrasonography of KUB)

.. 2552

4)

19

eGFR

(

4)

3.1 1 2 12
( 6 )
3.2 3 6
( 12
)
3.3 4 3
( 6 )
3.4 5 3

20

4.1
4.1.1 eGFR 30-59 mL/min/1.73m2
7 mL/min/1.73m2
(

4)

4.2
4.2.1 eGFR 30-59 mL/min/1.73m2
7 mL/min/1.73m2

4)

4.2.2 eGFR 30 mL/min/1.73m2

(

4)

4.2.3 1,000 mg
spot urine protein/creatinine ratio 1,000
mg/g creatinine

.. 2552

4)

21

5.1
130/80 mmHg
(

1)

5.2 angiotensin
converting enzyme inhibitor (ACEI) angiotensin receptor blocker (ARB)
(

1)

5.3 ACEI ARB

1)

5.4 ACEI ARB

(SCr) (serum K)
[3]
SCr
30% 4 serum K
5.5 mmol/L
(

22

3)

5.5
2
(

2)

[3] , GFR
ACEI ARB

(.)
GFR (mL/min/1.73m2)
GFR (%)
(mmol/L)

120
60
< 15
4.5

110 -119
30 - 59
15 - 30
4.6 - 5.0

< 110
< 30
> 30
> 5

BP

.. 2552

4-12 2-4 < 2

6-12 3-6 1-3

23

6.1 (proteinuria)

UPCR 500-1,000 mg/g creatinine
(

2)

6.2 (proteinuria)

2)

6.3 ACEI ARB

2)

6.4
ACEI ARB
( c 1 , 2 )

24

4)

7.1

7.1.1 (Preprandial capillary plasma
glucose) 90-130 mg/dL (5.0-7.2 mmol/L)
(

2)

7.1.2 (Peak postprandial capillary plasma glucose) 180 mg/dL (<10.0

mmol/L)
(

2)

7.1.3 (HbA1C) 7.0%

(

2)

7.1.1 7.1.2
HbA1C 6
(

4)

7.2
7.2.1

(
.. 2552

2)

25

7.2.2
7.2.2.1 biguanide (metformin) :
serum creatinine 1.5 mg/dL
1.4 mg/dL
(

4)

7.2.2.2 sulfonylurea
chlorpropamide :
(

2)

glybenclamide :

eGFR 30 mL/min/1.73m2
(

4)

glipizide gliclazide :

eGFR 10 mL/
min/1.73m2

3)

7.2.2.3 alpha-glucosidase inhibitors :

acarbose miglitol
eGFR 30 mL/min/1.73m2
(

26

4)

7.2.2.4 metiglinide (repaglinide) :

4)

nateglinide
eGFR 30 mL/min/
1.73m2
(

4)

7.2.2.5 thiazolidinedione :

2)

Rosiglitazone

2)

7.2.3

.. 2552

2)

27

8.1
LDL cholesterol 100 mg/dL
(

3)

70 mg/dL

(

3)

8.2

statin
(

2)

8.3 statin

28

2)

.. 2552

1)

29

 10

10.1

10.1.1 eGFR 30 mL/min/1.73m2 ( 4-5)
0.6 /[4]
(

2)

10.1.2 eGFR 30 mL/min/1.73m2 ( 1-3)

0.6-0.8 /
(

2)

10.1.3 (high
biological value protein)

60
(

2)

10.2
10.2.1 60 35 /
/
(

3)

[4] ()
= () 100
= () 110
30

10.2.2 60 30-35 /
/
(

3)

10.3

ACEI
[5]
(

3)

[5]

(100-200 / 1 )

(250-350 / 1 )

.. 2552

31

10.4
100
(2,300 )
(

3)

10.5
(body mass index, BMI)

4)

10.6 (serum albumin)

3-6 3.5 g/dL

1)

10.7
(Dietary protein intake) 3-6
normalized protein catabolic rate
(nPNA) [6]

[6] UNA = UUN (g N/day) + NUN (g N/day)

NUN = 0.031 g N x body weight in Kg
PNA = UNA x 6.25
[UNA = urea nitrogen appearance, UUN = 24-hour urinary urea nitrogen (g N/day),
N = nitrogen, NUN = non urea nitrogen (g N/day), PNA = protein equivalent of total
nitrogen appearance (g protein/day)]
32

 nPNA dietary recall

food record
(

4)

10.8 24
3-6
(

.. 2552

3)

33

 11

11.1 serum calcium (Ca)

phosphate (P)
(

2)

11.1.1 corrected serum Ca 9.0-10.2 mg/dL

11.1.2 serum P 2.7-4.6 mg/dL
11.1.3 serum Ca x P 55 (mg/dL)2
11.2 serum P

(phosphate binder)
(

2)

11.3

2)

11.4 5
(Hyperparathyroidism)
(intact parathyroid hormone, iPTH)
iPTH 150-300 pg/mL
(

34

1)

 12

12.1 Hemoglobin (Hb) 10.0 g/dL

erythropoiesis stimulating agent (ESA)
(

2/3)

12.2 ESA
Hb 10.0 g/dL
serum ferritin 100 ng/mL
Transferrin saturation (TSAT) 20%
ESA 3
(

2)

serum ferritin 500 ng/mL

2)

12.3 ESA Hb 10.0

g/dL
(

13.0 g/dL
(

.. 2552

3)
1)

35

 13

(
22 mmol/L)
(

36

3)

 14
non steroidal antiinflammatory drugs (NSAIDs) COX2 inhibitors
aminoglycosides radiocontrast agents

.. 2552

4)

37

 15
15.1

(hepatitis B vaccine)
2 3 (0, 1, 6 )
deltoid
1 (anti
HBs <10 IU/L)
(

2)

15.2 4
(influenza vaccine)
(

38

3)

 16

16.1

(very high risk)
(

1)

16.2

(

3)

16.2.1 (Chest x-ray)

16.2.2 (EKG)
16.3

(

3)

16.4

.. 2552

3)

39

 17
17.1
4 (eGFR < 30 mL/min/
1.73m2)
(

4)

17.2 4

4)

17.3
(vascular access)
4 arterio-venous
fistula
(

40

3)

 42 ()

..
..
..
..
.
.
.

..

.
..
.
.
..
..
.
.
.
.

..

43

 2
12 2552

1 1-4

2 5-6

..

.
.
.
.
.
..

44

..
.
...
.
.
..
.

3 7-9

4 10-11

.
.
..
..
..
.

..
..
.
...
.
.
.
.
.

5 12-14

6 15-17

.
.
..
..
..
..
.
.

.
..
..
.
..

 3 (eGFR) MDRD
( mL/min/1.73m2)

(mg/dL)
0.8
0.9
1.0
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
2.0
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
3.0
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
4.0
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
5.0
5.1
5.2
5.3
5.4
5.5
5.6

20

30

40

>90
>90
>90
>90
82
75
69
63
59
55
51
48
46
43
41
39
37
35
34
32
31
30
28
27
26
26
25
24
23
22
22
21
20
20
19
19
18
18
17
17
17
16
16
15
15
15
14
14
14

>90
>90
>90
84
76
69
63
58
54
51
47
44
42
40
38
36
34
32
31
30
28
27
26
25
24
24
23
22
21
21
20
19
19
18
18
17
17
16
16
16
15
15
15
14
14
14
13
13
13

>90
>90
88
79
71
65
60
55
51
48
45
42
40
37
35
34
32
31
29
28
27
26
25
24
23
22
21
21
20
19
19
18
18
17
17
16
16
16
15
15
14
14
14
13
13
13
12
12
12

.. 2552

()
50
>90
> 90
84
75
68
62
57
53
49
46
43
40
38
36
34
32
31
29
28
27
26
25
24
23
22
21
20
20
19
19
18
17
17
16
16
16
15
15
14
14
14
13
13
13
13
12
12
12
12

60

70

80

>90
>90
81
73
66
60
55
51
47
44
41
39
36
34
33
31
29
28
27
26
25
24
23
22
21
20
20
19
18
18
17
17
16
16
15
15
15
14
14
14
13
13
13
12
12
12
11
11
11

>90
89
79
70
64
58
53
49
46
43
40
37
35
33
32
30
29
27
26
25
24
23
22
21
21
20
19
18
18
17
17
16
16
15
15
15
14
14
13
13
13
13
12
12
12
11
11
11
11

>90
86
76
68
62
56
52
48
44
41
39
36
34
32
31
29
28
27
25
24
23
22
22
21
20
19
19
18
17
17
16
16
15
15
15
14
14
13
13
13
13
12
12
12
11
11
11
11
10

45

 4 (eGFR) MDRD
( mL/min/1.73m2)

(mg/dL)
0.6
0.7
0.8
0.9
1.0
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
2.0
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
3.0
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
4.0
4.1
4.2

46

20

30

40

>90
>90
>90
85
75
67
61
56
51
47
44
41
38
36
34
32
30
29
27
26
25
24
23
22
21
20
20
19
18
18
17
17
16
16
15
15
14

>90
>90
90
78
69
62
56
51
47
43
40
38
35
33
31
29
28
26
25
24
23
22
21
20
19
19
18
17
17
16
16
15
15
14
14
14
13

>90
>90
84
74
65
58
53
48
44
41
38
35
33
31
29
28
26
25
24
23
22
21
20
19
18
18
17
16
16
15
15
14
14
14
13
13
12

()
50
>90
>90
81
70
62
56
51
46
42
39
36
34
32
30
28
26
25
24
23
22
21
20
19
18
18
17
16
16
15
15
14
14
13
13
13
12
12

60

70

80

>90
>90
78
68
60
54
49
44
41
38
35
33
31
29
27
26
24
23
22
21
20
19
18
18
17
16
16
15
15
14
14
13
13
12
12
12
11

>90
88
75
66
58
52
47
43
40
36
34
32
30
28
26
25
23
22
21
20
19
19
18
17
16
16
15
15
14
14
13
13
12
12
12
11
11

>90
86
73
64
57
51
46
42
38
35
33
31
29
27
25
24
23
22
21
20
19
18
17
16
16
15
15
14
14
13
13
13
12
12
11
11
11

NOTE:

NOTE: