高血压与糖尿病肾病进展PPT.ppt

Walking the dog ?2006. American College of Physicians. All Rights Reserved. Incidence of Kidney Failureper million population, 2000, by HSA, unadjusted ?2006. American College of Physicians. All Rights Reserved. Diabetes:The Most Common Cause of ESRD Primary Diagnosis for Patients Who Start Dialysis Diabetes 50.1% Hypertension 27% Glomerulonephritis 13% Other 10% United States Renal Data System. Annual data report. 2000. No. of patients Projection 95% CI 1984 1988 1992 1996 2000 2004 2008 0 100 200 300 400 500 600 700 r2=99.8% 243,524 281,355 520,240 No. of dialysis patients (thousands) ?2006. American College of Physicians. All Rights Reserved. Cardiovascular Comorbidities, 5% Medicare sample, by Diabetes and CKD status, 1999-2000 %Stroke/TIA %ASHD %Amputation/PVD %Heart Failure ?2006. American College of Physicians. All Rights Reserved. Level of Kidney Function Is an Independent Risk Factor For CV Risk N=15,350 Mean follow-up=6.2 years Age -45-64 Stage of Kidney Disease N Stage 2 (GFR-60-89) 7,665 Stage 3 4 (GFR-15-59) 444 1.0 1.25 1.75 1.5 2.0 1.38 1.16 Manjunath G et.al JACC 2003;41:47-55 0.75 ?2006. American College of Physicians. All Rights Reserved. Go, A. S. et al. N Engl J Med 2004;351:1296-1305 ?2006. American College of Physicians. All Rights Reserved. CKD Hospitalization Rates for Cardiovascular Disease CHF admission rates are 5 times higher in patients with a diagnosis of CKD vs non-CKD Ischemic heart disease admissions at 2-2.5 times higher in the CKD population Cardiac arrhythmia admission rates are twice as common in CKD populations ?2006. American College of Physicians. All Rights Reserved. CKD Prevalence in US (AJKD 2002) GFR (ml/min) 15 15-29 30-59 60-89 90 ?2006. American College of Physicians. All Rights Reserved. CVD Risk Factors Hypertension* Cigarette smoking Obesity* (BMI 30 kg/m2) Physical inactivity Dyslipidemia* Diabe