1

ISBN 978-616-7323-67-1

.indd 1

SD-18.10-002

27/08/55 16:18:38


ISBN
978-616-7323-67-1
1 2555

17,500

144

50 4
2 47
10310
0-2716-6091, 0-2716-7450 0-2718-1900
http://www.nephrothai.org

120 3 2-4
80 5 2550
10210
0-2141-4000 0-2143-9730
http://www.nhso.go.th

66/180 . . 80 22
0-2935-5331 0-2932-7877

.indd 2

27/08/55 16:18:49

()





.. 2552

2
22 2554

9 2554

.indd 3

27/08/55 16:19:16



1

(Screening, monitoring, and referral criteria)

1

2

3

(estimated glomerular filtration rate : eGFR)

4

5

6

1
2
3
4
6
8
9

2 (BP and proteinuria control) 15

7
16
3 (Reducing CVD risk)

8

9

10

23
24
29
33

4

11

12

13

14

15

16

17

18

19

39
40
41
46
49
52
55
59
65
68

.indd 4

27/08/55 16:19:19

 5 (Managing complications of CKD) 77

20
78

21
79

22
81

23
82
6

(Prevent complication and preparation for RRT)

24

25

26
7 (CKD Clinic)



(CKD Clinic)

CKD Clinic

:

92
93
94
105
106
116
121

5
128
129
130

1

2

3

91

.indd 5

27/08/55 16:19:21

.indd 6

27/08/55 16:19:23

Screening, monitoring and referral criteria

...
.

.indd 1

27/08/55 16:19:26

1. 3 (glomerular filtration rate, GFR)

1.1 2 3

- microalbuminuria

- proteinuria 500 ./
Urine protein creatinine ratio(UPCR) >500 mg/g Protein dipstick 1+

- (hematuria)

1.2 , ,

1.3

2. GFR 60 .//1.73 3

5 1

1
2
3
4
5

1:

GFR (.//1.73 )
GFR
> 90
GFR
60 89
GFR
30 59
GFR
15 29

< 15 ()

.indd 2

27/08/55 16:19:33

(estimated glomerular
filtration rate : eGFR)



1.1

1.2

1.3

1.4 60

1.5 Vasculitis, SLE

1.6

1.7 (> 3 /)

1.8

1.9

1.10 NSAIDS (Nephrotoxic agents)

1.11

1.12 3

.indd 3

27/08/55 16:19:39


3
(estimated
glomerular filtration rate: eGFR)

1. eGFR 1
(serum creatinine, SCr)

2. enzymatic method
eGFR
modified kinetic Jaffe reaction

3. 2
1.01 mg/dl

4. eGFR CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
2
2:
serum creatinine (mg/dl)
< 0.7
> 0.7
< 0.9
> 0.9

eGFR CKD-EPI

GFR = 144 (SCr/0.7)-0.329 (0.993)Age

GFR = 144 (SCr/0.7)-1.209 (0.993)Age

GFR = 141 (SCr/0.7)-0.411 (0.993)Age

GFR = 141 (SCr/0.7)-1.209 (0.993)Age


5. CKD-EPI creatinine clearance (CCr)
Crockcoft-Gault equation 1.73 m2

CCr (ml/min) = (140-) x ()
x 0.85
Scr x 72

(body surface areaBSA) Mosteller (m2)

= ((Height(cm.)Weight (kg.))3600)

.indd 4

27/08/55 16:19:42


60 72 170 serum creatinine 1.5
mg/dl

CCr = 53.3 ml/min.

BSA = 1.68 m2

Adjusted CCr = (53.3*1.73)/1.68 = 54.8 .//1.73


6. eGFR

.indd 5

27/08/55 16:19:45

1. (Dipstick)
1

- 1
(protein dipstick) 1+
1-2 6 2 3

- proteinuria dipstick microalbuminuria
microalbumin (microalbuminuria dipstick)
1-2 6 2 3

2. microscopic examination
1 2
3 hematuria

3. (plain KUB) / (ultrasonography of KUB)

4. 1-3

.indd 6

27/08/55 16:19:49

 1:

Scr eGFR protein dipstick

eGFR>60 .//1.73

eGFR<60 .//1.73

protein diqstick

eGFR 3

>1+

eGFR > 60 .//1.73

(CKD)

microalbuminuria

1-2 6
2 3

*
1.
2.
3.
4. 60
5. Vasculitis SLE
6.
7. (3 /)
8.
9.
10. NSAIDS
11.
12. 3

eGFR < 60 .//1.73

(CKD)

.indd 7

27/08/55 16:20:05

(estimated Glomerular Filtration rate; eGFR) (
2)
3

1-2
3
4
5

3:
eGFR (.//1.73 )
60
6-12
30-59
3-6
15-29
2-3
<15/
1-3

.indd 8

27/08/55 16:20:07

( 1-3)

1. CKD 3 (eGFR 60 .//1.73 )

(eGFR) 7 .//1.73 /

3

1,000 mg spot urine protein/creatinine ratio
1,000 mg/g cr (Dipstick) proteinuria 4+
3

2. CKD 4 (eGFR < 30 .//1.73 )

1. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al. A
new equation to estimate glomerular filtration rate. Ann Intern Med. 2009 May

5;150(9):604-12.

2. Myers GL, Miller WG, Coresh J, Fleming J, Greenberg N, Greene T, et al.

Recommendations for improving serum creatinine measurement: a report from the

Laboratory Working Group of the National Kidney Disease Education Program.

Clin Chem. 2006 Jan;52(1):5-18.

3. Stevens LA, Schmid CH, Greene T, Zhang YL, Beck GJ, Froissart M, et al.

Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the
Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR

levels above 60 mL/min/1.73 m2. Am J Kidney Dis. 2010 Sep;56(3):486-95.

4. Early Identification and Management of Chronic Kidney Disease in Adults in Primary

and Secondary Care. http://www.nice.org.uk/cg73.

5. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in

chronic kidney disease. Am J Kidney Dis 2004; 43:S1.

6. KDOQI clinical practice guidelines for chronic kidney disease: evaluation, classification,

and stratification. Am J Kidney Dis 2002;39(2 suppl 1):S1S266.

.indd 9

27/08/55 16:20:11

Note :

10

.indd 10

27/08/55 16:20:15

Note :

11

.indd 11

27/08/55 16:20:17

Note :

12

.indd 12

27/08/55 16:20:20

Note :

13

.indd 13

27/08/55 16:20:22

Note :

14

.indd 14

27/08/55 16:20:24

15

..

.indd 15

27/08/55 16:20:27

16

1.
angiotensin converting enzyme inhibitor (ACEI) angiotensin receptor blocker (ARB)
130/80 .
> 130/80mmHg Calcium channel blockers (CCB),
diuretic, beta blocker

ACEI / ARB
angioedema 5.5 ./.

ACEI / ARB
30 6-8
3.0 ./.

2. thiazide
30 .//1.73 2 loop
diuretics 30 .//1.73 2

.indd 16

27/08/55 16:20:29

 2 :

130/80 .

Secondary hypertension *

**

1)
2)

150/90 . 150/90 .

ACEI ARB

150/90 .

ACEI/ARB CCB ACEI, ARB,
ACEI/ARB
CCB, beta-blocker***
diuretic
diuretic
CCB diuretic
CCB
beta-blocker

130/80 . /
1
2
3 1-3

17

ACEI/ARB
CCB
ACEI/ARB
diuretic

150/90 .

130/80 .
/

.indd 17

27/08/55 16:20:31

18

*

1) 25 55



2)

3) 30

ACEI ARB

4)

.

.

.

. abdominal bruit

.



.

.
**1-3

1. (body mass index) 18.5-24.9 ./..

2. 1

3.

30 3

4.
*** Beta-blocker 60

1. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint Nationa
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood

Pressure: the JNC 7 report. JAMA. 2003;289:2560-72.

2. Appel LJ, Giles TD, Black HR, et al. ASH Position Paper: Dietary approaches to

lower blood pressure. J Clin Hypertens (Greenwich). 2009;11:358-68.

3. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in
chronic kidney disease. Am J Kidney Dis. 2004;43:S1-290.

4. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management

of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension
of the European Society of Hypertension (ESH) and of the European Society of

Cardiology (ESC). J Hypertens. 2007;25:1105-87

.indd 18

27/08/55 16:20:33

Note :

19

.indd 19

27/08/55 16:20:35

Note :

20

.indd 20

27/08/55 16:20:37

Note :

21

.indd 21

27/08/55 16:20:39

Note :

22

.indd 22

27/08/55 16:20:41

..
.

23

.indd 23

27/08/55 16:20:43

24

4:

- (HbA1c)
- 7 *
- ( 8 ) - 70-130 ./.
- ( 1-2 - 180 ./.
)

-
- 130/80 .
-
- 30 ./

(30 ./)
- LDL
- 100 ./.

( 70 ./.



)
- HDL
- 40 ./.

50 ./.
-
- 150 ./.
*
(HbA1c 6.5)

.indd 24

27/08/55 16:20:45

25

7,8 ( 5)
1. biguanide (metformin) : 1.5 ./.
1.4 ./. ( metformin eGFR
30 .//1.73 .. eGFR 30-60 .//1.73 .. 9-11)
2. sulfonylurea
chlorpropamide :
glybenclamide : eGFR 30 .//1.73 ..
glipizide gliclazide :
eGFR 10 .//1.73 ..
3. alpha-glucosidase inhibitors : acarbose miglitol eGFR
30 .//1.73 ..
4. metiglinide (repaglinide) :
nateglinide eGFR 30 .//1.73 ..
5. thiazolidinedione :

6. dipeptidyl peptidase-4 (DPP-4) inhibitors :

sitagliptin Vildagliptin

7. : 1 2
( HbA1c 10,
250 ./. (random) 300 ./.)

2
(eGFR 30 .//1.73 ..)
25
GFR 10-50 .//1.73 .. 50 GFR 10 .//1.73
..

.indd 25

27/08/55 16:20:46

 5:

26

eGFR 30-60
eGFR < 30eGFR
(.//1.73 )

1. bignanide (metformin)
r


2. sulfonylurea
- chlorpropamide
r
r
- glybenclamide

r
- glipizide

eGFR < 10
- gliclazide

eGFR < 10
3. alpha-glucosidase inhibitors
- acarbose

r
- miglitol

r
4. metiglinide
- repaglinide

- nateglinide

r
5. thiazolidinedione

6. dipeptidyl peptidase-4 (DPP-4) inhibitors

- sitagliptin



50 .
25 .
- Vildagliptin



50 .
50 .
7.

.indd 26

27/08/55 16:20:49


< 130/80 mm Hg

HbA1c < 7%

ACE inhibitor
ARB

< 30 mg/g
creatinine
LDL

fibrate
nicotinic acid

statin

HDL

> 40 mg/dl ( )
> 50 mg/dl ( )

< 100 mg/dl

-
-

- ( 30
)
-

3:

.indd 27

27

27/08/55 16:20:51

28

1. Standards of medical care in diabetes-2011. American Diabetes Association.

Diabetes Care 2011;34 Suppl 1:S11-54.

2. Reichard P, Nilsson BY, Rosenqvist U. The effect of long-term intensified insulin

treatment on the development of microvascular complications of diabetes mellitus.

N Engl J Med 1993; 329:3049.

3. DCCT. Effect of intensive therapy on the development and progression of diabetic

nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control

and Complications (DCCT) Research Group. Kidney Int 1995;47:170320.

4. UKPDS. Effect of intensive blood-glucose control with metformin on complications in
overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study
(UKPDS) Group. Lancet 1998;352:85465.

5. UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with

conventional treatment and risk of complications in patients with type 2 diabetes

(UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:83753.

6. McMahon GT. Hyperglycemia. In:Mushlin SB, Greene HL,eds.Dcision making in medicine.

3th ed. Philadelphia:Moby Elsevier, 2010:128-31.

.
.. 2552.

7. Reilly JB, Berns JS. Selection and dosing of medications for management of diabetes
in patients with advanced kidney disease. Semin Dial 2010; 23:163-8.

8. Vasisht KP, Chen SC, Peng Y, Bakris GL. Limitations of metformin use in patients with

kidney disease: are they warranted?. Diabetes Obes Metab 2010;2:1079-83.

9. Herrington WG, Levy JB. Metformin: effective and safe in renal disease. Int Urol

Nephrol 2008;40:411-7.

10. McCormack J, Johns K, Tildesley H. Metformins contraindications should be

contraindicated. CMAJ 2005; 173:5024.

.indd 28

27/08/55 16:20:53

1. (dyslipidemia)
1.1 Total cholesterol,
low density lipoprotein (LDL), high density lipoprotein (HDL) Triglycerides (TG)
12

LDL = Cholesterol HDL (Triglyceride/5)

1.2
2-3 1
2-3

2. (secondary causes) 6

29

6:

*Nephrotic syndrome
Excessive alcohol consumption
**Hypothyroid
Liver disease
***Diabetes

13-cis-retinoic acid
Androgens
Anticonvulsants
Oral contraceptive
Highly active anti-retroviral therapy
Cyclosporine
Diuretic HCTZ
Sirolimus
Non-selective Beta-blockers Proponolol
(b1 selective blockers atenolol metoprolol

carvedilol (non selective Beta-blocker
with alpha 1selective blocking activity)
TG HDL-C)
*Nephrotic syndrome: 3 / dyslipidemia

**Hypothyroid: dyslipidemia hypothyroid
***Glucose Intolerance: dyslipidemia dyslipidemia

.indd 29

27/08/55 16:20:55


3. LDL
100 mg/dL 4 (7 8)
7:

30

*
-

-
-
- 50-60
-

- ( < 1.0 ; <0.8)
- (Body Mass Index) 18.5-23 kg/m2
- <90 <80

- 10
- 20-30 3-4

* ()

.indd 30

27/08/55 16:20:57

 8:

eGFR 60-90 eGFR15-60 eGFR<15

Simvastatin
20-80 mg 10-40 mg 10-40 mg
Atorvastatin
10-80 mg 10-80 mg 10-80 mg
Lovastatin
20-80 mg 10-40 mg 10-40 mg
Fluvastatin
20-80 mg 10-40 mg 10-40 mg
Pravastatin
20-40 mg 20-40 mg 20-40 mg
Nicotinic acid
1.5-3 g
1.5-3 g
Nicotinic acid
1-2 g
1-2 g 50%
34%
Extended release


Chlolestyramine
4-16 g
4-16 g
4-16 g
Rosuvastatin
10 mg
5-10 mg
5-10
Ezitimibe
10 mg
10 mg
10 mg
Gemfibrozil
600 mg bid 600 mg bid* *




Cr > 2 mg/dL
Fenofibrale
50% 25%

31

4. LDL 70 mg/dL
statins

5. statins statins fibrates, nicotinic acid,
cyclosporin, azole, macrolides, protease inhibitors, non-dihydropyridine
calcium antagonist amiodarone
(myopathy) creatine kinase (CK)

6. CK 10 statin

7. Statin, fibrates endocrinologist

.indd 31

27/08/55 16:20:59

 4:

triglyceride 500 mg/dL

fibrate niacin

LDL 100

LDL 100-129 mg/dL

LDL 130 mg/dL

2-3 LDL
100 mg/dL
statin

statin

TG 200 mg/dL
non HDL 130 mg/dL

32

statin

LDL 130 mg/dL

bile sequestrant*
nicotinic

.indd 32

27/08/55 16:21:02


10

33

.indd 33

27/08/55 16:21:04

Note :

34

.indd 34

27/08/55 16:21:05

Note :

35

.indd 35

27/08/55 16:21:07

Note :

36

.indd 36

27/08/55 16:21:09

Note :

37

.indd 37

27/08/55 16:21:11

Note :

38

.indd 38

27/08/55 16:21:13

39

.. .
..
..

.indd 39

27/08/55 16:21:15


11

40

,

(Body Mass Index, BMI)

3

3.5 /

(Dietary protein intake)

(food record)

5:

.indd 40

27/08/55 16:21:17


12

60
35 1 60
30 1

()

* x
()

()

() 70 160 55

= 55 x 30

= 1,650

(Ideal body
weight)

60 30 1

41

= * x

()

()

()

*
(Ideal body weight) () = () 100
(Ideal body weight) () = () 105

.indd 41

27/08/55 16:21:19

 3 0.8-1.0
1 4-5 0.6-0.8
1 60 %
(High Biological Value HBV)

() 160
= () 105

= 160 105

= 55
4 0.6
1 = 0.6 x 55

= 33
9: (Ideal body weight)
1. 0.8 1

42

()


()

45
36

50
40

55
44

60
48

65
52

70
56

75
60

80
64

(60 % )
(/)
6
7
8
8
9
10
10
11

.indd 42

27/08/55 16:21:21

2. 0.7 1


()


()

45
31.5

50
35

55
38.5

60
42

65
45.5

70
49

75
52.5

80
56

(60 % )
(/)
5
6
7
7
8
8
9
10

3. 0.6 1

(60 % )
(/)
5
5
6
6
7
7
8
8

43

()


()

45
27

50
30

55
33

60
36

65
39

70
42

75
45

80
48

.indd 43

27/08/55 16:21:24

 10:
/ *
() () ()
()
() () () () ()
15

10

1,300

20

10

1,400

25

10

1,500

30

4.5

10

1,500

35

10

1,600

40

10

1,600

45

4.5

10

1,700

50

10

10

1,800

55

11

10

1,850

60

12

10

1,900

44

.indd 44

27/08/55 16:21:27



33
3
11:

45

() ()



13
370

-
2
-
2
- 2
-
2
-
1

2

8
500

- 2

-
1/2
- 2
- 1
- 4
- 1
- 1
3

12
650

- 5
- 1
- 1
- 2

- 2
-
1
2.5
() 1
-
1/2
- 2


33
1,520

.indd 45

27/08/55 16:21:29


13

46

(Protein)



2

1. (High Biological Value HBV)

//


2. (Low Biological Value LBV)


(HBV)
: 7 = 1 = 2 = 30

2 1

/
( )

( )

( )

( )

.indd 46

27/08/55 16:21:37

: 7 = 1 = 2 =
30

240 .
()

()

()

4
()

()

/
()

47

(LBV)
:

/
()

.indd 47

27/08/55 16:21:43



1. Puwastien P, Raroengwichit M, Sungpuag P, Judprasong K. Thai food composition

tables 1999. 1st ed. Nakorn Pathom: Institute of Nutrition, Mahidol University

(INMU); 1999.

2. Inman JI. A Clinical Guide to the Nutritional Care of the Renal Patient. New England
Center for Nutrition Education, Inc, Stoughton, MA, 1999. In: Lutz AC, Przytulski KR.

Nutrition & diet therapy: evidence based applications. 4th ed. Philadelphia:

F.A. Davis Co., c; 2006.

3. Meeting the challenge of the renal diet. A preview of the National Renal Diet

educational series. J Am Diet Assoc. 1993 Jun; 93(6): 637 9.

4. . . 2545

5. . Nephrology. .
2546: 1567 658.

6. Jutamas Onnom. The effect of high seasoning protein on nutritional status in continuous

ambulatory peritoneal dialysis patient. [M.Sc. Thesis in Food and nutrition for d

evelopment]. Nachonprathom: Faculty of Graduate Studies: Mahidol University; 2010.

48

.indd 48

27/08/55 16:21:45


14

(Carbohydrate)
/ 2 ( 2 /)
()

/
: / 1 = 1 = 70

49

2 2

.indd 49

27/08/55 16:21:49

/
: / 1 = 1 = 70

1/2

/ / 1

/ 6

50

1
()

1
()

1/2
()

1
()

1
( )

1/4
()

1/2
()

1
()

3/4

1/2

()

(
)

(
)

.indd 50

27/08/55 16:21:56



1. Puwastien P, Raroengwichit M, Sungpuag P, Judprasong K. Thai food composition

tables 1999. 1st ed. Nakorn Pathom: Institute of Nutrition, Mahidol University (INMU); 1999.

2. Inman JI. A Clinical Guide to the Nutritional Care of the Renal Patient. New England
Center for Nutrition Education, Inc, Stoughton, MA, 1999. In: Lutz AC, Przytulski KR.
Nutrition&diet therapy: evidencebased applications. 4thed. Philadelphia: F.A. Davis Co., c; 2006.

3. Meeting the challenge of the renal diet. A preview of the National Renal Diet

educational series. J Am Diet Assoc. 1993 Jun; 93(6): 637 9.

4. , . .

5. . . 2545

6. . Nephrology. .

2546: 1567 658.

51

.indd 51

27/08/55 16:21:58


15

(Fat)
(Mono-unsaturated fatty acid)
(Poly-unsaturated fatty acid) (Saturated fatty
acid)

(Saturated fatty acid)

52

(Mono-unsaturated fatty acid)

(Poly-unsaturated fatty acid)

: 1 45
(Saturated fatty acid)
-
1

-
1

.indd 52

27/08/55 16:22:01

-
-
-
-
-
- /

1
2
1
1
1
2

(Mono-unsaturated fatty acid)

-
1

-
1

-
1

- / 6

-
10

-
1

-
1

-

-

1
1

53

(Poly-unsaturated fatty acid)

-
1

-
1

-
1

-
1

-
1

- /
1

******
/

.indd 53

27/08/55 16:22:03

. .
()
)
. . LDL HDL((
)

54

7. Puwastien P, Raroengwichit M, Sungpuag P, Judprasong K. Thai food composition
tables 1999. 1st ed. Nakorn Pathom: Institute of Nutrition, Mahidol University (INMU); 1999.

8. Inman JI. A Clinical Guide to the Nutritional Care of the Renal Patient. New England

Center for Nutrition Education, Inc, Stoughton, MA, 1999. In: Lutz AC, Przytulski KR.

Nutrition&diet therapy: evidencebased applications. 4thed. Philadelphia: F.A. Davis Co., c; 2006.

9. Meeting the challenge of the renal diet. A preview of the National Renal Diet

educational series. J Am Diet Assoc. 1993 Jun; 93(6): 637 9.

10. . . 2545

11. . Nephrology. . 2546:

1567 658.

12. Jutamas Onnom. The effect of high seasoning protein on nutritional status in

continuous ambulatory peritoneal dialysis patient. [M.Sc. Thesis in Food and nutrition

for development]. Nachonprathom: Faculty of Graduate Studies: Mahidol University; 2011.

.indd 54

27/08/55 16:22:06


16

2,000

3
6-60

61-120

120

()
15
25
55
61 - 120
80
80
250

12: ()

55

.indd 55

27/08/55 16:22:08

 13:

56

1
1
1
1
1
1
1
1
1
1
1
1

()
2,000
500
500
490
400
400
340
450
280
220
210
140

( 6 60 mg/)

.indd 56

27/08/55 16:22:10

 ( 61 120 mg/)

, //,

( > 120 mg/); 2,000

/

57

,

( 1 )

/
/ /

,
( 1 )

.indd 57

27/08/55 16:22:14

 ( > 120 mg/); 2,000

/ ()

58

,
/ // /

1. Puwastien P, Raroengwichit M, Sungpuag P, Judprasong K. Thai food composition tables
1999. 1st ed. Nakorn Pathom: Institute of Nutrition, Mahidol University (INMU); 1999.

2. Gebhardt SE, Thomas R.G. Nutritive value of food. United States Department of

Agriculture. 2002.

3. . . : ; 2551.

4. , . Nutrition assessment and management.

: , , . (), Textbook
of peritoneal dialysis. : . 2551; 1:643-677.

5. Niratchaporn Janejob. Developing a nutrition education tool : booklet for sodium content
guideline in Thai foods. [M.Sc. Thesis in Food and nutrition for development].

Nachonprathom: Faculty of Graduate Studies: Mahidol University; 2006.

6. Suchaya Satitpitakul. The effect of dietary counseling and using sodium booklet on
sodium intake reduction in hypertensive patients. [M.Sc. Thesis in Food and nutrition

for development]. Nachonprathom: Faculty of Graduate Studies: Mahidol University; 2009.

7. Traipop Meechai. Development of a multimedia website nutrition education tool for meal
planning in hypertensive subjects. [M.Sc. Thesis in Food and nutrition for development].

Nachonprathom: Faculty of Graduate Studies: Mahidol University; 2010.

.indd 58

27/08/55 16:22:16


17

5.2 mEq/L
1 3

3.5 mEq/L
1 /, 2 /, 3 /
4 /

59

(1/6 101 )

(4 77 )

(1 102 )

(1 100 )

(5 75 )

(1/2 76 )

(1/2 80 )

(5 78 )

( 70 mg/)

.indd 59

27/08/55 16:22:20

 ( 70 mg/)

(1/2 135 )

(1 84 )

(1/2 50 )

( 150 mg/)

60

(2 152 )

(3 205 )

(6 384 )

(2 150 )

(15 93 )

(15 93 )

(2 130 )

(1 91 )

(4 55 )

(1/2 87 )

(1 147 )

(5
159 )

.indd 60

27/08/55 16:22:26

 ( 150 mg/) ()

(5 94 )

(1/2 57 )

(4-5 45 )

(10 117 )

(2 132 )

(1/2 80 )

61

(1/2 53 )

(1 48 )

(1/2 166 )

(1/2 22 )

(2
61 )

(3 25 )

(3 25 )

(2 18 )

(2 36 )

(3-4 117 )

(1 53 )

.indd 61

27/08/55 16:22:33

 ( 270 mg/)

(1/3 120 )

(6
130 )

(15
160 )

(2 22 )

(1/2 22 )

(1 122 )

(1/3 123 )

(12 180 )

(1/8 170 )

(1/8 188 )

(2 18 )

(1/2 80 )

(10
56 )

(1 250 )

(1 250 )

(1 250 )

(1 250 )

(1 250 )

62

.indd 62

27/08/55 16:22:40

 ( 70 mg 1 2 )

, , , , , , ,, , , , ,
, , , , , , , ,
, , , , , ,

( 70-150 mg 1 2 )

63

, , , , , , , , ,
, , , , , , , , ,
, , /, , , , , ,
, , ,

.indd 63

27/08/55 16:22:42

 ( 150 mg 1 2 )

, , , , ,, , , , ,
, , , , ,, , ,
, , , , , , , , , , ,
, , , , , (), , , , ,
, , , , ,

64

13. Puwastien P, Raroengwichit M, Sungpuag P, Judprasong K. Thai food

composition tables 1999. 1st ed. Nakorn Pathom: Institute of Nutrition, Mahidol

University (INMU); 1999.

14. Gebhardt SE, Thomas R.G. Nutritive value of food. United States Department of

Agriculture. 2002.

15. . . : ; 2551.

16. Inman JI. A Clinical Guide to the Nutritional Care of the Renal Patient. New England
Center for Nutrition Education, Inc, Stoughton, MA, 1999. In: Lutz AC, Przytulski KR.

Nutrition & diet therapy: evidence based applications. 4th ed. Philadelphia:

F.A. Davis Co., c; 2006.

17. Meeting the challenge of the renal diet. A preview of the National Renal Diet

educational series. J Am Diet Assoc. 1993 Jun; 93(6): 637 9.

.indd 64

27/08/55 16:22:45


18

(Phosphorus)

65

-


-


-

.indd 65

27/08/55 16:22:47

-
-
-

-
-
-
-

66

.indd 66

27/08/55 16:22:50



18. Puwastien P, Raroengwichit M, Sungpuag P, Judprasong K. Thai food composition

tables 1999. 1st ed. Nakorn Pathom: Institute of Nutrition, Mahidol University (INMU);
1999.

19. Inman JI. A Clinical Guide to the Nutritional Care of the Renal Patient. New England

Center for Nutrition Education, Inc, Stoughton, MA, 1999. In: Lutz AC, Przytulski KR.
Nutrition & diet therapy: evidence based applications. 4th ed. Philadelphia: F.A. Davis

Co., c; 2006.

20. Meeting the challenge of the renal diet. A preview of the National Renal Diet

educational series. J Am Diet Assoc. 1993 Jun; 93(6): 637 9.

21. . . 2545

22. . Nephrology. .

2546: 1567 658.

23. Jutamas Onnom. The effect of high seasoning protein on nutritional status in

continuous ambulatory peritoneal dialysis patient. [M.Sc. Thesis in Food and nutrition

for development]. Nachonprathom: Faculty of Graduate Studies: Mahidol University; 2011.

67

.indd 67

27/08/55 16:22:52


19

(Purine)
(Uric acid)
3.4 7 /



(Purine moderate diet) (Purine free
diet)

(0 50 /100 )

68
/

//*

: *

.indd 68

27/08/55 16:22:58

 (50 - 100 /100 g)

69

.indd 69

27/08/55 16:23:06

 (> 150 /100 g)

70

.indd 70

27/08/55 16:23:16

1. Ruilope LM, Garcia-Puig J: Hyperuricemia and renal function.Curr Hypertens

Rep 2001;3: 197-202.

2. Satirapoj B. Uric Acid and Kidney Disease. R Thai Army Med J 2010; Vol. 63

No. 2 April-June: 81-6

3. Schlesinger N. Dietary factors and hyperuricaemia. Curr Pharm Des 2005; 11(32):4133e8.

4. L. Kathleen Mahan and Sylvia Escott-Stump. Krauses food and nutrition therapy.
12th ed. Missouri: Saunders elsevier, 2008.

5. Corinne HR, Marilyn RL, Wanda LC, et al. Normal and Therapeutic Nutrition. 17th ed.

Prentice Hall, 1990

6. 13:2522. Available at

http://nutrition.anamai.moph.go.th/gult.htm.

71

.indd 71

27/08/55 16:23:17

Note :

72

.indd 72

27/08/55 16:23:19

Note :

73

.indd 73

27/08/55 16:23:21

Note :

74

.indd 74

27/08/55 16:23:24

Note :

75

.indd 75

27/08/55 16:23:25

Note :

76

.indd 76

27/08/55 16:23:27

(Managing complications of CKD)

.. .
.
.
.

77

.indd 77

27/08/55 16:23:29


20

6 : 4-5

4-5
serum calcium phosphate 3 6
Intact Parathyroid Hormone (iPTH) 6

78
corrected serum calcium 9 10.2 mg/dl
serum phosphate 2.7 4.6 mg/dl
serum calcium phosphate 55 (mg/dl)2
iPTH 150 300 (pg/ml)

-

-
-

(phosphate binder)
iPTH active vitamin D

.indd 78

27/08/55 16:23:32


21

1:
7:
CKD stage ( stage 3-5 ) Hemoglobin(Hb) 1

Hb 13.5 g/dL Hb 12.0 g/dL

79

- Complete blood count(CBC) and peripheral blood smear

- Red blood cell indices
mean corpuscular hemoglobin [MCH],
mean corpuscular volume [MCV],
mean corpuscular hemoglobin concentration [MCHC]
- Stool occult blood stool exam for parasite
- Absolute reticulocyte count
- Iron study serum Ferritin, serum iron
total iron binding capacity(TIBC) Transferrin saturation (TSAT = serum iron x 100/TIBC)

Hb 10 g/dL
Erythropoiesis
stimulating agent (ESA) (subcutaneous)
Hb 10 -12 g/dL

.indd 79

27/08/55 16:23:34

 2 : Erythropoietin ()

- ESA 50-150 /./ 12

1-2 g/dL

- Hb 1 Hb

2-3

- Hb

25% 3-6 iron deficiency

(Serum ferritin < 100 ng/mL TSAT <20%) iron supplement

- ESA Hb 12 g/dL

ESA 25%

- ESA Hb < 10 g/dL ESA 20,000

300 Hb 12



- ESA pure red cell aplasia

blood transfusion blood transfusion

(kidney transplantation)

80

.indd 80

27/08/55 16:23:36


22

1 -5 serum bicarbonate

1- 2
12
3
6

4-5
3

serum bicarbonate 22-24 mEq/L sodium bicarbonate
300 mg 6-12 3-4 serum bicarbonate

81

.indd 81

27/08/55 16:23:38


23

(Acute kidney injury; AKI)
(Renal replacement therapy; RRT)

82

1.1
(Chronic kidney disease)
60 (Old age)
(Diabetes mellitus)
(Liver disease)
(Congestive heart failure)
(Volume depletion)
1.2 AKI



( 2)



14:
15:

.indd 82

27/08/55 16:23:40

 14 :

, ,
, AKI

AKI




1
2
AKI
3 (once daily dose)
4
BUN, Cr , Electrolyte, Mg
AKI
(Cr >1.5 mg/dl GFR<60
ml/min/1.73m2), ,
, contrast ,
multiple myeloma
AKI
1 0.9% NSS 1 ml/kg/hr 12
IV contrast (
)
2 Acytylcysteine 600 mg oral 12
IV contrast
3 low iso-osmolar contrast agent
contrast
4 IV contrast 24-48
BUN, Cr 24-48
contrast Cr

Hemodialysis
7-10

83

1. NSAIDs
Hemodynamic (prerenal)
Diclofenac, Ibuprofen, Acute tubular necrosis
Naproxen, Sulindac, Indomethacin Acute interstitial nephritis
Meloxicam, Piroxicam
Nephrotic syndrome
2. COX-2 inhibitor

Celecoxib, , Etoricoxib
3. Aminoglycoside
Acute tubular necrosis
Gentamicin, Amikacin, Distal tubular dysfunction
Netilmicin, Streptomycin













4. Radiocontrast
Renal vasoconstriction
Acute tubular necrosis
CT-SCAN

.indd 83

27/08/55 16:23:42

 14 : ()

84

5. crystal nephropathy Intrarenal obstruction

Acyclovir, Indinavir,
Ciprofloxacin, Sulfonamides





6. ACE-I/ARB
Decreased
Enalapril, Captopril, intraglomerular pressure
Lisinopril, Ramipril, Perindopril,
Losartan, Irbesartan, Candesartan,
Valsartan







7. Amphotericin B
Renal vasoconstriction





























8. (Herbs)
Acute interstitial nephritis
Intratubular obstruction
Chinese Herbs Urothelial carcinoma
Aristolochic acid

AKI

IV 1-2

BUN, Cr
bilateral renal artery stenosis

NSAIDs AKI


BUN, Cr, K Cr
30%


( 50%)
AKI
1
Aminoglycoside
2
AKI
NSS 500 ml IV
4-6 Amphotericin B
( IV
)
3 Amphotericin B
6

BUN, Cr , Electrolyte, Mg
liposomal formulation
AKI

.indd 84

27/08/55 16:23:44

 15 :

85

Creatinine clearance (ml/min)

()
10-50
<10
Acyclovir
5-10 mg/kg q 8 h
5-10 mg/kg q 12-24 h
5-10 mg/kg q 24 h
Amikacin#
15 mg/kg/day
4 mg/kg/day
7.5 mg/kg q 72 h
Amoxicillin
500 mg q 8 h
500 mg q 12 h
500 mg q 24 h
Amoxicillin(1g)/

1.2 g
1.2 g
1.2 g q 8 h
clavulanic acid (0.2g)

600 mg q 12 h 600 mg q 24 h
Ampicillin
1 g q 6 h
1 g q 8-12 h
1 g q 24 h
Cefazolin
1 g q 6 h
1 g q 12 h
1 g q 24 h
Cefepime
2 g q 8 h
2 g q 12 h
2 g q 24 h
Cefixime (oral)
200 mg q 12 h
200 mg q 12 h
200 mg q 24 h
Cefoperazone(1g)/
1.5 g q 8 h
1.5 g q 12 h
1.5 g q 12 h
sulbactam (0.5g)
2 g q 8 h
2 g q 12 h
2 g q 24 h
Cefotaxime
ceftazidime
2 g q 8 h
2 g q 12 h
2 g q 24 h
Cephalexin (oral)
500 mg q 6 h
500 mg q 8 h
500 mg q 12 h
Ciprofloxacin
400 mg q12 h
400 mg q24 h
400 mg q24 h
Ciprofloxacin (oral)
500 mg q12 h
500 mg q24 h
250 mg q24 h
Clarithromycin (oral)
500 mg q 12 h
500 mg q 12 h
250 mg q 12 h
Fluconazole
200-400 mg q 24 h
100-200 mg q 24 h
100-200 mg q 24 h
Gentamicin#
5 mg/kg/day
2.5 mg/kg/day
2 mg/kg q 72 hr
Imipenem/cilastatin
500 mg q 6 h
250 mg q 6 h
250 mg q 12 h
Itraconazole (oral)
200 mg q 12 h
200 mg q 12 h
100 mg q 12 h
Lamivudine (oral)
150 mg q 12 h
150 mg q 24 h 50 mg q 24 h
Levofloxacin
750 mg q 24 h
750 mg q 48 h
750 mg q 48 h
Meropenem
1 g q 8 h
1 g q 12 h
1 g q 24 h
Metronidazole
500 mg q 8 h
500 mg q 8 h
250 mg q 8 h
Netilmicin
6.5 mg/kg q 24 h
2 mg/kg q 24 h
2 mg/kg q 72 h
Ofloxacin (oral)
200 mg q 12 h
200 mg q 12 h
200 q 24 h
Oseltamivir (oral)
75 mg q 12 hr CrCl10-30 ml/min: 75 mg q24h
Penicillin G
0.5-4 mU q 4-6 h
0.375-3 mU q 4-6 h
0.25-2 mU q 4-6 h
Piperacillin/tazobactam
4.5 g q 6 h
2.25 g q 6 h 2.25 g q 8 h
Stavudine (oral)
30 mg q 12 h
15 mg q 12 h 15 mg q 24 h
Trimethoprim/ sulfame- TMP:5-20mg/kg/day
TMP:2.5-10mg/kg/day

thoxazole(TMP/SMX)
6-12 h
6-12 h
Vancomycin#
1 g q 12 h
1 g q 24 h
1 g q 4-7 day
Zidovudine (oral)
300 mg q 12h
300 mg q 12h
100 mg q 8 h
Antituberculosis
Ethambutol (oral)
15-25 mg/kg/day CrCl < 30 ml/min:15-25 mg/kg 3
Pyrazinamide (oral)
20-30 mg/kg/day CrCl < 30 ml/min:20-30 mg/kg 3
Streptomycin
BW >50 kg: 1 g/day
CrCl < 30 ml/min:12-15 mg/kg 3

BW <50 kg:750mg/day

#
1. The sanford guide to antimicrobial therapy 2010. 40thed.
2. Drug information handbook international. 17th ed.
3. Drug prescribing in renal failure: Dosing guideline for adults and children. 5th ed.

.indd 85

27/08/55 16:23:47

Note :

86

.indd 86

27/08/55 16:23:49

Note :

87

.indd 87

27/08/55 16:23:51

Note :

88

.indd 88

27/08/55 16:23:53

Note :

89

.indd 89

27/08/55 16:23:54

Note :

90

.indd 90

27/08/55 16:23:56

91

.
.

.indd 91

27/08/55 16:23:58


24

92

Hepatitis B vaccine

1. (HBsAg)

(antiHBs-antibody)

2.



3.

(Hepatitis B vaccine) 16
Influenza vaccine

1.





2. 4 5 (Influenza vaccine)

16
16 :




1


Hepavax
-20 mcg/1.0 mL 2
Recombivax HB 2

Engerix-B
-40 mcg/1.0 mL




2 Influenza, Trivalent
0.5 mL

inactivated vaccine


Live,


Attenuated Influenza


Vaccine (LAIV)

0, 1 6
antiHBs-Ab 1

3
1
*

.indd 92

27/08/55 16:24:00


25

3 1-3

93

.indd 93

27/08/55 16:24:02


26

94

5 15

4

3

1.

2.

3.

1. (Hemodialysis)

2-3 4-5

( 1-2)
2. (Continuous ambulatory peritoneal dialysis)
4-6


4
( 3-4)

.indd 94

27/08/55 16:24:04


3. (kidney transplantation) ()

( 5)

95

3 4

.indd 95

27/08/55 16:24:07

 17 :

96

4-5 /

2-3 /

4-5 .








/









/

.indd 96

27/08/55 16:24:09

 ()

(2-3

150,000-

()

)12,000-25,000 15,000-25,000

250,000

()

()

~ 20,000

(3-6 )

-15,000 (6-12 )

-10,000 ( 1 )

2,000

20,000

1,000

-1,500

97

( )

.indd 97

27/08/55 16:24:11

 ()

()

( (

1 . 2551

1,500

) )

98

.indd 98

27/08/55 16:24:13

 8 :

99

.indd 99

27/08/55 16:24:15

Note :

100

.indd 100

27/08/55 16:24:17

Note :

101

.indd 101

27/08/55 16:24:19

Note :

102

.indd 102

27/08/55 16:24:21

Note :

103

.indd 103

27/08/55 16:24:22

Note :

104

.indd 104

27/08/55 16:24:24

.. .
..
.

(CKD Clinic)

105

.indd 105

27/08/55 16:24:26



(CKD Clinic)

106

5




200,000

Thailand Renal Replacement Therapy Registry 2550
26,000
10 1
1 2
9 :
1997-2009
Patient per million population (pmp)
140

123.18

120

100.34

100
80

68.34

60
40
20
0

10.2

10.2

11.8

1997

1998

1999

10.4
2000

23.4
2001

2007

2008

2009

.indd 106

27/08/55 16:24:28

 10 :
1997-2009
Patient per million population (pmp)
600

496.93

500

419.95

400
300

234.4 236.4 275.3

200
100
0

552.8

30

54.4

302.6

114.8
78.9 99.4

1997 1998 1999 2000 2001 2003 2001 2005 2006 2007 2008 2009

107

5
1-4
5
..2
18 17.7% ( 7 )
1-4

2550
5,200
26,000 10

.indd 107

27/08/55 16:24:30






(Holistic Medicine)

108

(CKD Clinic Model) St. Pauls

Hospital Vancouver
.. 1993




3-5


(CKD Clinic Model)

(CKD Clinic Model)

(CKD clinic)

1

.indd 108

27/08/55 16:24:32

11 : CKD clinic model

(CKD clinic)

1.

2.

3.

4.

5.

(CKD clinic)

2


1. 2

109

12 : OPD

.indd 109

27/08/55 16:24:34

1.1

110

1.1.1

1.1.1.1 3 (estimated GFR 30-59 ml/min/1.73m2)

1.1.1.2 4-5 (estimated GFR < 30 ml/min/1.73m2)
1.1.2

1.1.2.1

1.1.2.2

1.1.2.3

1.2

1.2.1

3 4


1.2.1.1

1.2.1.1.1



(estimated Glomerular Filtration Rate, eGFR)



1.2.1.1.2

1.2.1.1.3



1.2.1.1.4




Clinical practice guidelines


1.2.1.2



1.2.1.2.1



CKD clinic



1.2.1.2.2 CKD clinic



1.2.1.2.3



CKD Clinic



1.2.1.2.4

1.2.2 1

.indd 110

27/08/55 16:24:36

1.2.2.1 (patient care)

1.2.2.1.1

1.2.2.1.2


130/80 mmHg

1.2.2.1.3


neck vein distension jugular venous pressure

1.2.2.1.4

1.2.2.1.5




1.2.2.1.6 (life style)




1.2.2.1.7

1.2.2.1.8

1.2.2.1.9
1.2.2.2 (Coordination management)


1.2.2.3 (Information and communication)

1.2.2.4 (Change management)

1.2.2.5 (Financial management)

111

1.2.3 1



1.2.3.1



(co morbidity)

.indd 111

27/08/55 16:24:38

1.2.3.2


1.2.3.3 (Mulnutrition)

1.2.3.4

1.2.3.5

1.3

1.3.1 3
1

1.3.2

1.3.3 1 2

112

1.4

1.4.1

1.4.1.1

1.4.1.2

1.4.1.3

1.4.1.4


CKD Clinic

1.4.1.5


Clinic
1.4.2

1.5



1.5.1 3 (eGFR 30 59 ml/min /1.73 m2) 6


( 12


3


)

.indd 112

27/08/55 16:24:40

1.5.2 4 (eGFR 15 29 ml/min /1.73 m2) 3

( 6

1-2 )

113

2. (Education program)



(Topic)

2.1 (Topic)


2.1.1 (Introduction to CKD)


2.1.2






2.1.3


2.1.4


2.1.5


2.1.6 3 Hemodialysis, Peritoneal dialysis



kidney transplantation


2.1.7


2.1.8 vascular access

2.2


2.2.1


2.2.2


2.2.3 Website CKD


2.2.4 power point


2.2.5 Food models

2.3


2.3.1 2



2.3.1.1 OPD



2.3.1.2

2.3.2



6-10 30-45


2.3.3

.indd 113

27/08/55 16:24:42

 13 :
3-4 (eGFR <60 ml/min/1.73m2)

3
(eGFR <60 ml/min/1.73m2)

4-5
(eGFR <30 ml/min/1.73m2)

1. (
)
2. ( )
3. ( )

114

- education class (6-10 classes )

- eGFR < 25 ml/min /1.73 m2
- eGFR < 20 ml/min /1.73 m2 pre-transplant assessment
hemodialysis
- eGFR < 15 ml/min /1.73 m2 CKD clinic

eGFR , electrolyte, calcium, phosphate, albumin, urine protein excretion rate, 3-6

< 7 mL/min/1.73m2/

< 7 mL/min/1.73m2/
/

.indd 114

27/08/55 16:24:46



1. Praditpornsilpa K. and The Thai Renal Replacement Therapy (TRT) Committee. Thailand

Renal Replacement Report Year 2007. http://www.nephrothai.org/index.asp

2. Ingsathit A, Thakkinstian A, Chaiprasert A, et al. Prevalence and risk factors of chronic

kidney disease in the Thai adult population: Thai SEEK study. Nephrol Dial Transplant

2010; 25:1567-1575

3. Levin AL, Lewis M, Mortiboy P, et al. Multidisciplinary predialysis programs: quantification

and limitations of their impact on patient outcomes in two Canadian settings. Am J Kid Dis

1997; 29:533540.

4. Curtis BM, Ravani P, Malberti F, et al. The short- and long-term impact of multidisciplinary

clinics in addition to standard nephrology care on patient outcomes. Nephrol Dial

Transplant 2004; 20:147154.

5. Goldstein M, Yassa T, Dacouris N, et al. Multidisciplinary predialysis care and morbidity

and mortality of patients on dialysis. Am J Kidney Dis 2004; 44: 706714.

6. Yeoh HH, Tiquia HS, Abcar AC, et al. Impact of predialysis care on clinical outcomes.

Hemodialysis Int 2003; 7:338341.

7. Thanamayooran S, Rose C, Hirsch DJ. Effectiveness of a multidisciplinary kidney disease

clinic in achieving treatment guidline targets. Nephrol Dial Transplant 2005;
115

20: 23852393

.indd 115

27/08/55 16:24:48

 CKD Clinic

116

(chronic kidney disease)

(end state renal disease)

-

-

-

-

- (
Mayo, 1965)

(chronic kidney disease)
3
(glomerular filtration rate; GFR) (
, , , 2550)

(noncompliance)

.indd 116

27/08/55 16:24:50

 14 :

117

CKD Clinic

-

-

-

-

-

Chronic care model

.indd 117

27/08/55 16:24:52

118

1.
(Direct care)

-

-

-

-

-

- , LAB

-

-

2. (Case management)

- counseling long term RRT

- vascular access

-

-

3. (Collaboratory)

-

- vascular access

-

-

4. (Counseling)

-

-


5. (outcome management and evaluation)
-
-

.indd 118

27/08/55 16:24:54

 15 : Flow role nurse in CKD clinic

Flow role nurse in CKD clinic

LAB

GFR < 20

RRT, Counseling,
vascular access

/
(BP, P, BW, LAB, Drug,
)

119

RRT, Counseling,
vascular access

//
//
//

.indd 119

27/08/55 16:24:57



1. .(2544). . (.),

:.: .

2. , , . (2550).

. , , ,

(.), Clinical dialysis ( 1-22). : .

3. . (2544). . (.),

: ( 17-55). : -.

120

.indd 120

27/08/55 16:24:58

3

1.

2.

3.

1. /

121

.indd 121

27/08/55 16:25:00


2. (
)
, ,
,
/,

- , ,


-

-

122

.indd 122

27/08/55 16:25:02

Note :

123

.indd 123

27/08/55 16:25:04

Note :

124

.indd 124

27/08/55 16:25:06

Note :

125

.indd 125

27/08/55 16:25:08

126

.indd 126

27/08/55 16:25:10


127

.indd 127

27/08/55 16:25:11

128

1. ..
2. ..
3. ..
4. .
5. .
6. .
7. ..
8. ..
9. ..
10. .
11. ..
12. .
13. .
14. .
15. .
16. ..
17. .
18. .
19. .
20. .
21. ...

.indd 128

27/08/55 16:25:13

1. .. .
2. ...
3. .
4. ..
5. ..
6. ..
7. .
8. .
9. .
10. .
11. .
12. .
13. .
14. ..
15. ..
16. ..

129

.indd 129

27/08/55 16:25:15

130

1 :
2
2 : eGFR CKD-EPI
4
1 :
7
3 :
8
2 :
17
4 :
24
5 :
26
3 :
27
6 :
29
7 :
30
8 :
31
4 :
32
5 :
40
9 :

Ideal body weight)
42-43
10 :
44
11 :
45
12 : ()
55
13 :
56
6 :

4-5
78
7 :
79
14 :
83-84
15 :
85
16 :
92
17 :
96-98
8 :
99
9 :

1997-2009
106
10 :

1997-2009
107
11 : CKD clinic model
109
12 : OPD 109
13 :
114
14 :
117
15 : Flow role nurse in CKD clinic
119

.indd 130

27/08/55 16:25:17

Note :

131

.indd 131

27/08/55 16:25:19

Note :

132

.indd 132

27/08/55 16:25:21

Note :

133

.indd 133

27/08/55 16:25:23

Note :

134

.indd 134

27/08/55 16:25:25

Note :

135

.indd 135

27/08/55 16:25:26

Note :

136

.indd 136

27/08/55 16:25:28

Note :

137

.indd 137

27/08/55 16:25:30

Note :

138

.indd 138

27/08/55 16:25:31