左卡尼丁与肾病学左卡尼丁与肾病学血液透析患者左卡尼丁治疗临床 .ppt

Despite improvement in the treatment of the anemia of chronic kidney disease, a large number of dialysis patients maintain a hemoglobin below the K/DOQI target range of 11 – 12 g/dl or a hematocrit of 33 – 36%. Data from the 2002 Clinical Performance Measures (CPM) report identifies that 24% of all dialysis patients have a hemoglobin below the target range and 8% have a hemoglobin below 10 g/dl / hematocrit 30%. The mean recombinant human erythropoietin dosage for patients with hemoglobin levels 9 g/dl is 550 units/kilogram/week and for patients with hemoglobin levels between 9 and 9.9 is 400 units/kilogram/week. There is still room for improvement to move dialysis patients into the target range. Patients that have hemoglobin levels below the target range should be assessed for clinical conditions that cause inadequate response to recombinant human erythropoietin treatment. Centers for Medicare and Medicaid Services. 2002 Annual Report ESRD Clinical Performance Measures Project. In 2002 the National Kidney Foundation convened an independent, interdisciplinary expert consensus panel to review the clinical, scientific and expert opinion on the use of L-carnitine in dialysis patients. Using a deliberative consensus building process, the panel developed practice recommendations. The practice recommendations were developed to assist in the implementation of the CMS policy on levocarnitine use in ESRD patients, and to provide additional explicit recommendations regarding diagnostic testing and treatment of DCD. The recommendations were published in American Journal of Kidney Diseases in April, 2003. The recommended starting dose of Carnitor? (levocarnitine) is 10-20 mg/kg dry body weight. A patient with a dry weight of 70kg would start at a dose of 700mg to 1400mg of Carnitor? Injection. Carnitor? Injection is for intravenous use only. The medication is to be given as a slow 2-3 minute bolus injection into the venous return line after each dialysis