【摘要】 目的 临床上针对慢性肾脏病(chronic kidney disease,CKD)和心力衰竭(heart failure,HF)患者在肾素-血管紧张素-醛固酮系统拮抗剂(renin–angiotensin–aldosterone system inhibitors,RAASi)应用和处理高钾血症的管理存在差异。本研究旨在建立CKD和HF患者中优化RAASi应用和高钾血症管理的多学科中国专家共识。方法 邀请来自中国不同地区有经验的的肾内科和心内科专家,应用名义小组技术(nominal group technique,NGT)讨论CKD和HF患者的高钾血症管理的挑战和建议。专家组提出了41条陈述/建议作为共识问卷,该问卷随后发给扩大的中国各地肾内科和心内科专家,通过改良的德尔菲技术评估每一项陈述/建议,给出强推荐(同意票≥75%且<90%)和非常强推荐(同意票≥90%)。建立专家组、数据收集和分析由独立的专业人员协助完成。结果 共有来自中国21个省的150名肾内科和心内科医生完成问卷,每个专业各75名。所有41条陈述/建议均达到了超过75%的共识同意的阈值,其中27条为非常强共识(≥90%同意),14条为强共识(75%～90%同意)。结论 基于问卷调查的结果,中国专家组提出了一系列推荐意见用于慢性肾脏病和心力衰竭患者优化RAASi应用和高钾血症管理。更多还原

【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 reninangiotension-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(n=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.更多还原