Zaoui P, Hannedouche T, Combe C
Pôle Digestif Uro-Néphro-Endocrinologie (DIGIDUNE), AGDUC, CHU Université Grenoble Alpes, Pole Santé, France.
Service de Néphrologie, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine, Strasbourg, France.
Nephrol Ther. 2017 Jun;13(6S):6S16-6S24. doi: 10.1016/S1769-7255(18)30036-1.
Type 2 diabetes has an increasing prevalence. Life expectancy is dominated by cardiovascular risk, which is the leading cause of death in these patients. Up to one third of diabetic patients will develop diabetic nephropathy related to micro-angiopathy. Renal impairment further increases cardiovascular risk. Reducing cardiovascular morbidity and mortality is a major public health issue, as well as early preventing and managing chronic kidney disease (CKD). Good glycemic control prevents the micro-vascular complications of the disease (retinopathy, nephropathy, etc.) and, more recently recognized through prolonged monitoring of the VADT cohort, prevents cardiovascular complications. Control of blood pressure and dyslipidemia are essential in primary or secondary cardiovascular prevention. In addition, the blockers of the renin-angiotensin system slow down the progression of the MRC. Elderly patients with chronic kidney disease (CKD) form another growing group of the nephrologist daily patient pool. Especially for very elderly patients with comorbidities, the question of favoring conservative treatment rather than starting or pursuing dialysis may arise. Survival and quality of life are indeed not necessarily better in elderly patients undergoing dialysis, complications can occur eventually leading to discontinuation, and are occasionally associated with a feeling of stubbornness. Creation of prognostic score is a useful tool to help the decision-making process. However, dialogue with the patient and his/her family, as well as multidisciplinary collaboration remain fundamentals to determine the most suitable care.
2型糖尿病的患病率正在上升。预期寿命主要受心血管风险的影响，心血管风险是这些患者的主要死因。高达三分之一的糖尿病患者会发生与微血管病变相关的糖尿病肾病。肾功能损害会进一步增加心血管风险。降低心血管发病率和死亡率是一个重大的公共卫生问题，同时也是早期预防和管理慢性肾脏病（CKD）的重要方面。良好的血糖控制可预防该疾病的微血管并发症（视网膜病变、肾病等），并且最近通过对VADT队列的长期监测发现，还可预防心血管并发症。控制血压和血脂异常在原发性或继发性心血管预防中至关重要。此外，肾素-血管紧张素系统阻滞剂可减缓MRC的进展。老年慢性肾脏病（CKD）患者构成了肾病科医生日常患者群体中另一组不断增加的人群。特别是对于患有合并症的高龄患者，可能会出现倾向于保守治疗而非开始或继续透析的问题。接受透析的老年患者的生存和生活质量不一定更好，最终可能会出现并发症导致透析中断，并且偶尔会伴有固执的感觉。创建预后评分是帮助决策过程的有用工具。然而，与患者及其家属的沟通以及多学科协作仍然是确定最合适治疗方案的基础。
