CKD的危险因素与防治对策-2010.12试题.ppt

结 语（二） CKD 防治的对策，主要是落实早期 防治、基础病防治、多靶点防治。 CKD多靶点防治的若干重点 降压达标是预防、延缓或逆转CKD进展基本措施之一。 ACEI/ARB应用得当，在减少蛋白尿/保护肾功能方面发挥重要作用。 现代饮食治疗（ LPD ，LPD＋?-KA/EAA）有独特优点，应合理应用。 防治贫血与血管钙化, 是延缓CKD进展、防治 CVD的重要措施之一。 防治间质纤维化-EMT, 是延缓CKD进展重要对策之一。 重视实验研究新成果，加强研发/临床试验/应用 * * 5 5 2 幻灯4 在一个为期5年的以社区为基础的随机，对照高血压病人三年随访研究中，Shulman等人证明血清肌酐浓度的增加与死亡率的危险增加有关。 在肌酐最低和最高层之间病人死亡率的风险几乎增加了5倍。正如累积生存率曲线所表明的：与血清肌酐增加有关系的死亡的绝对危险，开始于研究的第一年，随着时间的推移，在那些基线肌酐浓度更高的病人中则变得更为突出。该研究包括10，768名高血压病人，其中1064名病人有糖尿病。6 * * * * * * 控制血压可以延缓糖尿病及非糖尿病肾病患者GFR的降低，减轻肾损害。 * If diabetic nephropathy is left untreated, GFR declines steadily by 10–12 ml/min/1.73m2/year.1 In DETAIL, GFR declined over 5 years by 17.9 ml/min/1.73m2 in the LOCF dataset and 18.7 ml/min/1.73m2 in completers. The rate of decline slowed over time.2 Thus treatment with telmisartan halted the progression of diabetic nephropathy Parving H-H, et al. Angiotensin receptor blockers in diabetic nephropathy: renal and cardiovascular endpoints. Semin Nephrol 2004;24:147–151. Barnett A, et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004;351:1952–1961. * Among participants with baseline GFR 60, those assigned to chlorthalidone or lisinopril maintained level GFR values during the first two years of follow-up, with slightly declining levels to 4 years. Participants assigned to amlodipine had increased GFR values at 1 year and 2 years, with a subsequent decrease. The differences at all three follow-up time points between amlodipine and chlorthalidone were significant. * * 6 6 1 幻灯5 在一个328名白人NIDDM病人的前瞻性研究中，Gall等人研究的结果提示：在NIDDM病人中，在蛋白尿和所有原因的死亡率的危险之关存着一种关系，即随着蛋白尿的增加存活率降低。 * * Key message Prevalence of anaemia increases among CKD patients not only with increasing CKD stage but also with increasing severity of diabetes. Data was obtained from an Australian study across three diabetes centres, analysing outpatients with type 2 diabetes. Anaemia was defined by WHO guidelines o