慢性肾脏病和心力衰竭患者优化肾素-血管紧张素-醛固酮系统拮抗剂应用和高钾血症管理的中国多学科专家德尔菲共识

Ming-Hui Zhao; Wei Chen; Hong Cheng; Bi-Cheng Liu; Zhi-Guo Mao; Zhuang Tian; Gang Xu; Jing-Min Zhou

doi:10.24920/004327

Your Location：

Home >

Browse articles >

慢性肾脏病和心力衰竭患者优化肾素-血管紧张素-醛固酮系统拮抗剂应用和高钾血症管理的中国多学科专家德尔菲共识

中国医学科学杂志（英文） 2024年39卷第2期页码：79-90

指南与共识 | Updated：2025-03-07

- 慢性肾脏病和心力衰竭患者优化肾素-血管紧张素-醛固酮系统拮抗剂应用和高钾血症管理的中国多学科专家德尔菲共识
- Affiliations：
  
  1.Renal Division, Peking University First Hospital, Beijing 100034, China
  2.Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
  3.Department of Nephrology, Capital Medical University, Beijing 100029, China
  4.Department of Nephrology, Southeast University Zhongda Hospital, Nanjing 210009, China
  5.Department of Nephrology, Shanghai Changzheng Hospital, Shanghai 200003, China
  6.Department of Cardiology, Peking Union Medical College Hospital, Beijing 100730, China
  7.Renal Division, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
  8.Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Author bio：
  
  E-mail: mhzhao@bjmu.edu.cn.
- Funds：
- DOI：10.24920/004327
  中图分类号：
- 收稿日期：2023-12-05，
  
  录用日期：2024-04-08，
  
  网络出版日期：2024-06-05，
  
  纸质出版日期：2024-06-30
- Accepted：
Scan QR Code
慢性肾脏病和心力衰竭患者优化肾素-血管紧张素-醛固酮系统拮抗剂应用和高钾血症管理的中国多学科专家德尔菲共识[J]. 中国医学科学杂志（英文）, 2024,39(2):79-90.

Zhao Ming-Hui,Chen Wei,Cheng Hong,et al.A Chinese Multi-Specialty Delphi Consensus to Optimize RAASi Usage and Hyperkalaemia Management in Patients with Chronic Kidney Disease and Heart Failure[J].Chinese Medical Sciences Journal,2024,39(02):79-90.
慢性肾脏病和心力衰竭患者优化肾素-血管紧张素-醛固酮系统拮抗剂应用和高钾血症管理的中国多学科专家德尔菲共识[J]. 中国医学科学杂志（英文）, 2024,39(2):79-90. DOI： 10.24920/004327.

Zhao Ming-Hui,Chen Wei,Cheng Hong,et al.A Chinese Multi-Specialty Delphi Consensus to Optimize RAASi Usage and Hyperkalaemia Management in Patients with Chronic Kidney Disease and Heart Failure[J].Chinese Medical Sciences Journal,2024,39(02):79-90. DOI： 10.24920/004327.

摘要

Abstract

Objective

Variations are present in common clinical practices regarding best practice in managing hyperkalaemia (HK)

there is therefore a need to establish a multi-specialty approach to optimal renin-angiotension-aldosterone system inhibitors (RAASi) usage and HK management in patients with chronic kidney disease (CKD) & heart failure (HF).This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF.

Methods

A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique. The group then created a list of 41 statements for a consensus questionnaire

which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China. Consensus was assessed using a modified Delphi technique

with agreement defined as "strong" (≥75% and <90%) and "very strong" (≥90%). The steering group

data collection

and analysis were aided by an independent facilitator.

Results

A total of 150 responses from 21 provinces across China were recruited in the survey. Respondents were comprised of an even split (

=75

50%) between cardiologists and nephrologists. All 41 statements achieved the 75% consensus agreement threshold

of which 27 statements attained very strong consensus (≥90% agreement) and 14 attained strong consensus (agreement between 75% and 90%).

Conclusion

Based on the agreement levels from respondents

the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.

关键词

Keywords

references

Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group . KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int 2022 ; 102 ( 5 S): S1 - S127 . doi: 10.1016/j.kint.2022.06.008 http://dx.doi.org/10.1016/j.kint.2022.06.008 .

Expert Group on Kidney Clinical Quality Control Center in Shanghai . Guidelines for early screening, diagnosis, and prevention of chronic kidney disease (2022 edition) . Chin J Nephrol 2022 ; 38 ( 5 ): 453 - 64 . doi: 10.3760/cma.j.cn441217-20210819-00067 http://dx.doi.org/10.3760/cma.j.cn441217-20210819-00067 .

van de Wouw J , Broekhuizen M , Sorop O , et al . Chronic kidney disease as a risk factor for heart failure with preserved ejection fraction: a focus on microcirculatory factors and therapeutic targets . Front Physiol 2019 ; 10 : 1108 . doi: 10.3389/fphys.2019.01108 http://dx.doi.org/10.3389/fphys.2019.01108 .

Thomas MC , Cooper ME , Zimmet P . Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease . Nat Rev Nephrol 2016 ; 12 ( 2 ): 73 - 81 . doi: 10.1038/nrneph.2015.173 http://dx.doi.org/10.1038/nrneph.2015.173 .

McDonagh TA , Metra M , Adamo M , et al . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC . Eur J Heart Fail 2022 ; 24 ( 1 ): 4 - 131 . doi: 10.1002/ejhf.2333 http://dx.doi.org/10.1002/ejhf.2333 .

Wang H , Chai K , Du M , et al . Prevalence and incidence of heart failure among urban patients in China: a national population-based analysis . Circ Heart Fail 2021 ; 14 ( 10 ): e008406 . doi: 10.1161/CIRCHEARTFAILURE.121.008406 http://dx.doi.org/10.1161/CIRCHEARTFAILURE.121.008406 .

Clase CM , Carrero JJ , Ellison DH , et al . Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference . Kidney Int 2020 ; 97 ( 1 ): 42 - 61 . doi: 10.1016/j.kint.2019.09.018 http://dx.doi.org/10.1016/j.kint.2019.09.018 .

Simon LV , Hashmi MF , Farrell MW . Hyperkalemia . [ Updated 2022 Oct 12 ] . In: StatPearls [Internet ] . Treasure Island (FL) : StatPearls Publishing ; 2022 January .

Bian J , Zuo L , Zhao H , et al . Epidemiology and treatment pattern of hyperkalemia among outpatients in China: a descriptive study using an administrative database in China . Chin J Blood Purif 2020 ; 19 ( 11 ): 726 - 9 . doi: 10.3969/j.issn.1671-4091.2020.11.002. (Chinese http://dx.doi.org/10.3969/j.issn.1671-4091.2020.11.002.(Chinese )

Kanda E , Rastogi A , Murohara T , et al . Clinical impact of suboptimal RAASi therapy following an episode of hyperkalemia . BMC Nephrol 2023 ; 24 ( 1 ): 18 . doi: 10.1186/s12882-022-03054-5 http://dx.doi.org/10.1186/s12882-022-03054-5 .

Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group . KDIGO 2020 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int 2020 ; 98 ( 4 S): S1 - S115 . doi: 10.1016/j.kint.2020.06.019 http://dx.doi.org/10.1016/j.kint.2020.06.019 .

Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group . KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int 2021 ; 99 ( 3 S): S1 - S87 . doi: 10.1016/j.kint.2020.11.003 http://dx.doi.org/10.1016/j.kint.2020.11.003 .

Heidenreich PA , Bozkurt B , Aguilar D , et al . 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines . Circulation 2022 ; 145 ( 18 ): e895 - e1032 . doi: 10.1161/CIR.0000000000001063 http://dx.doi.org/10.1161/CIR.0000000000001063 .

Chinese Society of Nephrology . Guidelines for early screening, diagnosis, prevention and treatment of chronic kidney disease (2022 Edition) . Chin J Nephrol 2022 ; 38 ( 5 ): 453 - 64 . doi: 10.3760/cma.j.cn441217-20210819-00067. (Chinese http://dx.doi.org/10.3760/cma.j.cn441217-20210819-00067.(Chinese )

Chinese Society of Nephrology . Guidelines for hypertension management in patients with chronic kidney disease in China (2023) . Chin J Nephrol 2023 ; 39 ( 1 ): 48 - 80 . doi: 10.3760/cma.j.cn441217-20220630-00650. (Chinese http://dx.doi.org/10.3760/cma.j.cn441217-20220630-00650.(Chinese )

Heart Failure Group of Cardiovascular Physician Branch of Chinese Medical Doctor Association , Expert Consensus Working Group on Management of Hyperkalemia in Patients with Heart Failure in China . Expert consensus on management of hyperkalemia in patients with heart failure in China . Chin J Med 2021 ; 101 ( 42 ): 3451 - 8 . doi: 10.3760/cma.j.cn112137-20210624-01430. (Chinese http://dx.doi.org/10.3760/cma.j.cn112137-20210624-01430.(Chinese )

Chinese Medical Doctor Association Heart Failure Professional Committee , National Cardiovascular Expert Committee Heart Failure Professional Committee , Chinese Journal of Heart Failure and Cardiomyopathy Editorial Board . Expert consensus on ion management for patients with heart failure in China . Chin J HF CM 2020 ; 4 ( 1 ): 16 - 31 . doi: 10.3760/cma.j.cn101460-20200114-00004. (Chinese http://dx.doi.org/10.3760/cma.j.cn101460-20200114-00004.(Chinese )

Expert Group of Nephrology Branch of Chinese Medical Association . Expert consensus on serum potassium management practice in patients with chronic kidney disease in China . Chin J Nephrol 2020 ; 36 ( 10 ): 781 - 92 . doi: 10.3760/cma. j.cn441217-20200721-00139. (Chinese http://dx.doi.org/10.3760/cma.j.cn441217-20200721-00139.(Chinese )

Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease . Kidney Int 2024 , 105 ( Suppl 4S ): S117 – S314 .

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure . Circulation . 2022 ; 145 : e895 – e1032 . doi: 10.1161/CIR.0000000000001063 http://dx.doi.org/10.1161/CIR.0000000000001063

Zhang J , He X , Wu J . The impact of hyperkalemia on mortality and healthcare resource utilization among patients with chronic kidney disease: a matched cohort study in China . Front Public Health 2022 ; 10 : 855395 . doi: 10.3389/fpubh.2022.855395 http://dx.doi.org/10.3389/fpubh.2022.855395 .

Expert Group of Guidelines on the Management of Hyperkalemia in Maintenance Hemodialysis Patients in China . Guideline on the management of hyperkalemia in maintenance hemodialysis patients in China . Chin J Blood Purif 2022 ; 21 ( Suppl ): S1 - S16 . (Chinese)

Xue C , Mei C . Long-term management of hyperkalemia in chronic kidney disease . Chin J Nephrol . 2021 , 37 ( 4 ): 380 - 4 . DOI: 10.3760/cma.j.cn441217-20200623-00056. (Chinese http://dx.doi.org/10.3760/cma.j.cn441217-20200623-00056.(Chinese )

Dalkey N , Helmer O . An experimental application of the Delphi method to the use of experts . Management Sci 1963 ; 9 : 458 - 67 .

Diamond IR , Grant RC , Feldman BM , et al . Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies . J Clin Epidemiol 2014 ; 67 ( 4 ): 401 - 9 .

Jing X , Xu L , Qin W , et al . The willingness for downward referral and its influencing factors: a cross-sectional study among older adults in Shandong, China . Int J Environ Res Public Health 2020 ; 17 ( 1 ): 369 . doi: 10.3390/ijerph17010369 http://dx.doi.org/10.3390/ijerph17010369 .

Xiao Y , Chen X , Li Q , et al . Towards Healthy China 2030: modeling health care accessibility with patient referral . Soc Sci Med 2021 ; 276 : 113834 . doi: 10.1016/j.socscimed.2021.113834 http://dx.doi.org/10.1016/j.socscimed.2021.113834 .

Bernier-Jean A , Wong G , Saglimbene V , et al . Dietary potassium intake and all-cause mortality in adults treated with hemodialysis . Clin J Am Soc Nephrol 2021 ; 16 : 1851 - 61 . doi: 10.2215/CJN.08360621 http://dx.doi.org/10.2215/CJN.08360621 .

Yuan Lu , Bi-Cheng Liu & Hong Liu . An evaluation of sodium zirconium cyclosilicate: a new treatment option for hyperkalemia in China . Expert Opin Pharmacother 2023 ; doi: 10.1080/14656566.2022.2161884 http://dx.doi.org/10.1080/14656566.2022.2161884

Brown R , Bratton SL , Cabana MD , et al . Physician asthma education program improves outcomes for children of low-income families . Chest 2004 ; 126 ( 2 ): 369 - 74 . doi: 10.1378/chest.126.2.369 http://dx.doi.org/10.1378/chest.126.2.369 .

Silva-Cardoso J , Brito D , Frazão JM , et al . Management of RAASi-associated hyperkalemia in patients with cardiovascular disease . Heart Fail Rev 2021 ; 26 ( 4 ): 891 - 6 . doi: 10.1007/s10741-020-10069-3 http://dx.doi.org/10.1007/s10741-020-10069-3 .

Burton JO , Coats AJS , Kovesdy CP , et al . An international Delphi consensus regarding best practice recommendations for hyperkalaemia across the cardiorenal spectrum . Eur J Heart Fail 2022 ; 24 ( 9 ): 1467 - 77 . doi: 10.1002/ejhf.2612 http://dx.doi.org/10.1002/ejhf.2612 .

浏览量

1257

Downloads

CSCD

文章被引用时，请邮件提醒。

Submit

关联资源

暂无数据