糖尿病肾病的发病机制及应对策略终稿-带解说词 -En.pptx

Pathogenesis and prevention of diabetic kidney diseaseOutline231Epidemiology of diabetic kidney disease(DKD) Pathogenesis of DKD strategy for prevention Renal benefit data of DLAMICRON MRPrevention of diabetes and its long-term complicationsPrimary preventionPrevention of diabetesCVDMacrovascularSecondary preventionPrevention of long-term complications retinopathyDKDneuropathyMicrovascularTertiary preventionPrevention the progression of long-term complications中华医学会糖尿病学分会.中华糖尿病杂志.2014；6(7)：447-98.DKD—major diabetic microvascular complications neuropathyRetinopathyDKDDKD (diabetic kidney disease) diabetes induced chronic kidney disease GFR≤60ml/min/1.73m2or ACR ≧30mg/g for ＞3 months糖尿病肾病防治专家共识(2014版)Epidemiology of DKD in China 2009 to 2012Hospital-based T2DMCommunity-basedT2DMDKD prevalence30％-50％DKD prevalence40％糖尿病肾病防治专家共识(2014版)Trends in CKD patients Related to Diabetes and to Glomerulonephritis among HospitalizedPatients in ChinaZhang L, et al. N Engl J Med. 2016 Sep 1;375(9)905-6.Gradual decrease in eGFR in T2DMDevelopment and progression of DKDdecrease in eGFR and increase in UACR end-stagepreearlyovertalbuminuria(mg/d)‘eGFR(ml/min/1.73m2)Diabetic duration (years)Clifford J Bailey,et al. British Journal of Diabetes and Vascular Disease. 2012;12(4):167-171.DKD is the leading cause of ESRD2015 ANNUAL DATA REPORT of ESRD in USAFigure 1.16 Trends in (a) number of prevalent ESRD cases (in thousands) and (b) adjusted* prevalence (per million) of ESRD, by primary cause of ESRD, in the U.S. population, 1996-2013/2015/download/vol2_USRDS_ESRD_15.pdfHigh mortality in DKD-ESRD patientsSteno diabetes center cohort Mortality 8% (control group) vs. 30% (DKD group) 50% mortality in DKD group due to ESRD42761 T2DM followed by 4 years with progression of albuminuriaESRD increased by 30.6% and motality increased by 30.9%DIAMETRIC database19.5% DKD progressed to ESRD2.5 fold of that to CVD and 1.5 fold ofall-cause mortality ESRD.谢席胜, 等. 中国中西医结合肾病杂志, 2013; 14(10): 937-940Highe