336.2 🩺 國考版

336.2.1 高頻考點

336.2.1.1 4 Pillars CKD Treatment (MEMORIZE)

  1. ACE/ARB (proteinuria first-line)
  2. SGLT2i (CREDENCE, DAPA-CKD, EMPA-KIDNEY)
  3. Finerenone (FIDELIO/FIGARO)
  4. GLP-1 RA (FLOW 2024 semaglutide)

336.2.1.2 SGLT2i Trials

  • CREDENCE: canagliflozin DKD
  • DAPA-CKD: dapagliflozin CKD ± DM
  • EMPA-KIDNEY: empagliflozin
  • Cutoff: eGFR ≥ 20-25 (varies)

336.2.1.3 Finerenone

  • Non-steroidal selective MRA
  • FIDELIO-DKD (CKD progression)
  • FIGARO-DKD (CV events)
  • Less hyperkalemia than spironolactone

336.2.1.4 GLP-1 RA in CKD

  • FLOW (2024): semaglutide ↓ renal events 24%
  • Weight loss benefit
  • CV + renal protection

336.2.1.5 HIF-PHIs for Anemia

  • Roxadustat (Evrenzo)
  • Vadadustat (Vafseo)
  • Daprodustat (Jesduvroq)
  • FDA approval 2023

336.2.1.6 Hyperkalemia Treatment

  • Acute: Ca gluconate + insulin/glucose + β2 + bicarb if acidotic
  • Chronic: patiromer, SZC (sodium zirconium cyclosilicate)
  • Diet
  • Adjust ACE/ARB

336.2.1.7 CKD-MBD

  • Phosphate binders (non-Ca preferred)
  • Active vitamin D (calcitriol, paricalcitol)
  • Cinacalcet (oral), etelcalcetide (parenteral)
  • Parathyroidectomy refractory

336.2.1.8 Acidosis Treatment

  • Sodium bicarbonate
  • Target HCO3 22-26

336.2.1.9 Lipid Targets

  • LDL < 70 if eGFR < 60 + albuminuria
  • LDL < 55 if ASCVD established

336.2.1.10 Glycemic Targets

  • HbA1c < 7% (individualized)
  • Metformin OK until eGFR < 30
  • SGLT2i + GLP-1 RA preferred
  • Avoid hypoglycemia

336.2.1.11 Emerging Therapies

  • Sparsentan (FSGS, IgA)
  • Iptacopan (C3G, IgA)
  • Inaxaplin (APOL1 nephropathy)
  • Bardoxolone WITHDRAWN (CV concerns)
  • Eculizumab/ravulizumab (aHUS)
  • Belimumab (lupus nephritis)

336.2.2 易混淆比范

Pillar Mechanism Trial Key Benefit
ACE/ARB RAAS RENAAL, IDNT Proteinuria, CKD progression
SGLT2i Tubular Na CREDENCE, DAPA-CKD, EMPA-KIDNEY CKD + CV
Finerenone Selective MRA FIDELIO/FIGARO DKD progression + CV
GLP-1 RA Metabolic FLOW 2024, SUSTAIN-6 DKD + obesity + CV

336.2.3 Special Topics

336.2.3.1 Stages of SGLT2i Adoption

  • 2010s: DM-only indication
  • 2019-2020: CV benefit (DECLARE, EMPEROR)
  • 2020-2022: CKD ± DM (DAPA-CKD, EMPA-KIDNEY)
  • 2024: broader use, including non-DM

336.2.3.2 Statins in CKD

  • SHARP trial: simvastatin + ezetimibe ↓ CV events
  • Long-term safety in CKD established
  • Pre-dialysis: statins beneficial
  • Dialysis patients: less clear benefit (4D, AURORA)