5

1. 3



(glomerular filtration rate, GFR)

2. GFR 60 .//1.73

1
2

(.//1.73 )
> 90
60 89

30 59

15 29

8.9%
8.7%

< 15 ()


5 3 (
60 .//1.73 )
(2540) = 6.8% (1)
(2546) = 4.6% (2)
(2550) =
8.7%

5 1-2
(2550) = 8.9%

1. Chittinandana A, et al. J Med Ass Thai 2006.

2. Domrongkitchaiporn S, et al. J Am Soc Nephrol 2005.
3. Nephrology Society of Thailand. TRT registry 2007


5
(2549) = 17,047 (302.66
)
5
(2549) = 8,687 case (154.56 PMP)
5
200,000-300,000

1. Chittinandana A, et al. J Med Ass Thai 2006.

2. Domrongkitchaiporn S, et al. J Am Soc Nephrol 2005.
3. Nephrology Society of Thailand. TRT registry 2007

KDOQI. AJKD. 39, 2 (Suppl 1), 2002.

5
5
5 (autoimmune diseases)

5 (systemic infection)

5 (cardiovascular disease)

5
5
5 60
5

5 (Family history of
kidney disease)
5

5 estimated GFR (eGFR)

1
Modification of Diet in Renal
Disease (MDRD) Equation
eGFR (.//1.73 ..) = 186.3 x SCr-1.154
x Age-0.203 x (0.742 )

5 (Dipstick)
1+
urinary protein/creatinine index (UPCI)
(spot morning urine) 0.5


urinary albumin-creatinine ratio (UACR)
(spot morning urine) 30-300 ./.
microalbuminuria UACR
microalbuminuria dipstick

5 1 2 12
( 6 )
5 3 6 (
12 )
5 4 3 ( 6
)
5 5 3


5
eGFR 30-59 .//1.73 ..
7 mL/min per 1.73 m2 per
year


5
eGFR 30-59 .//1.73 ..
7 mL/min per 1.73 m2 per year

eGFR 30 .//1.73 ..
1,000 ./
spot urine protein creatinine ratio 1,000 ./.

KDOQI. AJKD. 39, 2 (Suppl 1), 2002.

TRT Registry 2004



5 (Preprandial capillary plasma
glucose) 90130 ./. (5.07.2 /)
5 (Peak postprandial
capillary plasma glucose) 180 ./. (<10.0
/)
5 (HbA1C) 7.0%

HbA1C 6

5

130/80 .

GFR (ml/min/year)

130
0

134

138

SBP

(mmHg)

142

146

-2

150

154

170

180

r = 0.69, p=0.02

-4
-6

Untreated
hypertension

-8

-10
-12
-14

Parving HH et al. Br Med J, 1989

Viberti GC et al. JAMA, 1993
Hebert L et al. Kidney Int, 1994
Lebovitz H et al. Kidney Int, 1994
Barkris GL et al. Kidney Int, 1996
Bakris GL. Hypertension, 1997

Bakris. Arch Intern Med, 161(22): 2661-2667; 2001.

5
angiotensin converting enzyme inhibitor (ACEI)
angiotensin receptor blocker (ARB)

5 ACEI ARB

5 ACEI ARB
serum Cr serum potassium (serum K)

serum Cr 30% 4
serum K 5.5 /
5
2


, GFR
ACEI ARB

(.)
GFR (.//1.73 .)
GFR (%)
(mEq/L)

BP

> 120
> 60
< 15
< 4.5

< 120
< 60
> 15
> 4.5

4
8

2
8

5 (proteinuria)

500 1000 ./.

5 (proteinuria)

5 ACEI ARB

5
ACEI
ARB

5
non steroidal anti-inflammatory drugs
(NSAIDs) COX2 inhibitors
radiocontrast agents

KDOQI. AJKD. 39, 2 (Suppl 1), 2002.

5 eGFR 30 .//1.73 .. ( 4 5) 0.6 /.

5 eGFR 30 .//1.73 .. ( 13) 0.6-0.8 /.
5
(high biological value protein)

60

5 60 35 ./.
/
5 60 30-35 .
/. /

100 (2,300 )


5 serum calcium (Ca)
phosphate (P)
corrected serum Ca 9.0-10.2 ./.
serum P 2.7 4.6 ./.
serum Ca x P 55 (./.)2

5 serum P

(phosphate binder)


5
(active vitamin D)
5
(Hyperparathyroidism)
(intact parathyroid
hormone, iPTH) iPTH
300 pg/ml


5 Hemoglobin
10.0 /.
erythropoiesis
stimulating agent (ESA)
5 erythropoiesis
stimulating agent (ESA) Hemoglobin
(Hb) 10.0 -12.0 ./.


5 erythropoiesis stimulating agent
(ESA) Hb
10.0 ./.
serum ferritin 100 ng/mL Transferrin saturation
(TSAT) 20% erythropoiesis
stimulating agent (ESA) 3
serum
ferritin 500 ./.

(
22 /)

KDOQI. AJKD. 39, 2 (Suppl 1), 2002.


5
5
5
5
5
5
5

KDOQI. AJKD. 39, 2 (Suppl 1), 2002.

5

(very
high risk)
5

(Chest x-ray)
(EKG)

(Traditional risk factor)

(Physical
inactivity)

(Uremic related risk factor)

(Divalent ion)


(Hyperparathyroidism)
(Proteinuria)
(Salt and water
overload)
(Anemia)
Thrombogenic factor
Homocystein

5
LDL cholesterol
100 ./. 70 /

5


statin

5 statin

5
echocardiography, exercise stress test
(EST), (cardiac catheterization)

5
(coronary
bypass)

KDOQI. AJKD. 39, 2 (Suppl 1), 2002.

5

4 (GFR < 30 ml/min)
5 4

5
(arteriovenous fistula)
4

KDOQI. AJKD. 39, 2 (Suppl 1), 2002.


5 eGFR <10 ml/min/1.73 m2

5 eGFR <6 ml/min/1.73 m2


Renal failure related symptoms

SR
Renal
D failure related symptoms

ESRD
Renal failure related symptoms

e
Pr

Renal failure related symptoms

Renal failure related symptoms

sis

D
SR
-E

Renal failure related symptoms

Di
aly

Pr
e-E

Renal failure related symptoms

Time

KDOQI. AJKD. 39, 2 (Suppl 1), 2002.h