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慢性肾病合并糖尿病患者治疗方式与《肾脏病预后质量倡议指南》建议的兼容性

The Compatibility of the Treatment Modalities to the Recommendations of the Kidney Disease Outcomes Quality Initiative Guideline in Chronic Kidney Disease Patients with Diabetes.

作者信息

Adibelli Zelal, Duran Cevdet

机构信息

Division of Nephrology, Department of Internal Medicine, Usak University, School of Medicine, Usak, Turkey.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Usak University, School of Medicine, Usak, Turkey.

出版信息

Iran J Public Health. 2021 Jun;50(6):1206-1212. doi: 10.18502/ijph.v50i6.6419.

Abstract

BACKGROUND

Diabetes mellitus (DM) and chronic kidney disease (CKD) are global growing health problems. Since DM is the major cause for CKD etiology, its development can be prevented with simple measures, like achievements of glycemic, lipid and blood pressure targets. This study aimed to evaluate whether the treatment goals for CKD patients with DM are achieved under the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline.

METHODS

Overall, 160 CKD patients with DM were enrolled in the study performed in Usak, Turkey from Jan 2016 to Jan 2018. Compatibility with treatment goals defined in KDOQI 2012 guideline for HbA1c levels, hypertension and dyslipidemia were evaluated retrospectively.

RESULTS

Of 160 CKD patients [15 (9.4%) in stage 3a, 53 (33.1%) stage 3b, 51 (31.9%) stage 4 and 41 (25.6%) stage 5], 23 patients in stage 5 were on hemodialysis. Total compliance rate to hyperglycemia treatment was 94 of 160 patients (58.8%). Compatibility rates between different stages of CKD were similar. Hypertension was detected only in 134 patients. Sixty-six (49.3%) patients were compatible with the treatment goals, and as the CKD stages progressed, the rate of patients achieving hypertension treatment goals was declined (=0.001). One-hundred and thirty-seven patients were not on hemodialysis and fifty-four (39.9%) of 137 patients achieved dyslipidemia goal. There was no difference between different stages of CKD.

CONCLUSION

Under KDOQI 2012 guideline, treatment goal for hyperglycemia was better achieved than the treatment goals for hypertension and dyslipidemia. In CKD patients with DM the physicians should be also focused on the treatment of hypertension and dyslipidemia.

摘要

背景

糖尿病(DM)和慢性肾脏病(CKD)是全球日益严重的健康问题。由于DM是CKD病因的主要原因,其发展可以通过简单的措施来预防,如实现血糖、血脂和血压目标。本研究旨在评估在肾脏病预后质量倡议(KDOQI)指南下,糖尿病CKD患者的治疗目标是否得以实现。

方法

总体而言,2016年1月至2018年1月在土耳其于斯屈达尔进行的一项研究中纳入了160例糖尿病CKD患者。回顾性评估其与KDOQI 2012指南中定义的糖化血红蛋白水平、高血压和血脂异常治疗目标的符合情况。

结果

160例CKD患者中[3a期15例(9.4%),3b期53例(33.1%),4期51例(31.9%),5期41例(25.6%)],5期的23例患者接受血液透析。160例患者中共有94例(58.8%)对高血糖治疗的总依从率达标。CKD不同阶段之间的达标率相似。仅在134例患者中检测到高血压。66例(49.3%)患者符合治疗目标,并且随着CKD阶段的进展,实现高血压治疗目标的患者比例下降(P=0.001)。137例未接受血液透析的患者中,54例(39.9%)实现了血脂异常目标。CKD不同阶段之间无差异。

结论

在KDOQI 2012指南下,高血糖治疗目标的实现情况优于高血压和血脂异常的治疗目标。对于糖尿病CKD患者,医生也应关注高血压和血脂异常的治疗。

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Hypertension Management in Diabetic Kidney Disease.糖尿病肾病的高血压管理
Diabetes Spectr. 2015 Aug;28(3):175-80. doi: 10.2337/diaspect.28.3.175.

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