糖尿病肾病的治疗 - MIME移动教育-迈德移动医学教 .ppt

小结 糖尿病肾病是ESRD的主要病因，未来会成为我国第一位的病因 糖尿病肾病的防治要关注血压、蛋白尿、血脂、血糖；而心血管合并症及死亡率是糖尿病及非糖尿病CKD患者的主要死因 替代治疗后糖尿病心血管合并症并未被抑制，肾移植在替代治疗中是需要着重发展的方式 Clin Ther. 2009 Nov;31(11):2608-17. Antidiabetic medication use and prevalence of chronic kidney disease among patients with type 2 diabetes mellitus in the United States. Koro CE, Lee BH, Bowlin SJ. Abstract OBJECTIVES: The aims of this study were to estimate the proportion of patients with type 2 diabetes mellitus (DM) in the United States with different stages of chronic kidney disease (CKD) and to describe glycemic control and antidiabetic drug use among them. METHODS: Using data from the Fourth National Health and Nutrition Examination Survey (NHANES IV) for the years 1999 through 2004, we performed a cross-sectional analysis of patients with type 2 DM aged or=20 years at the time of the survey interview. CKD stages were categorized according to the classification system established by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Anti-diabetic medication use among these patients was described using self-reported survey responses as well as survey medication files. RESULTS: A total of 1462 patients with type 2 DM were included in the analysis. Men and women constituted 48.3% and 51.7% of the study sample, respectively; 15.6% received a DM diagnosis 2 years ago, and 36.2% received their diagnosis 10 years ago. CKD was present in 39.7% of patients with DM. Mean (SE) glycosylated hemoglobin was lower in more advanced CKD stages, from stage 1 (8.35% [0.23%]) to combined stages 4 and 5 (6.63% [0.15%]). Based on the medication file data, the proportion of patients with CKD using 1 antidiabetic medication was higher as CKD progressed, from 36.3% at stage 1 to 62.9% at stages 4 and 5 (P = 0.007). By self-report, the proportion of patients with CKD using insulin alone was 6.7% at stage 1 and 38.8% at stages 4 and 5 (P 0.001). The proportion of patients using oral antidiabetic agents alone was 69.0% at stage 1 and