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糖尿病患者与非糖尿病患者慢性肾脏病(CKD)与心血管风险关联的见解

Insights into the Association of Chronic Kidney Disease (CKD) and Cardiovascular Risk Among Diabetic vs Non-Diabetic Patients.

作者信息

Singh Akashkumar N, Swathi Tatineni

机构信息

Department of Internal Medicine, Spandan Multispeciality Hospital, Manjalpur, Vadodara, India.

Senior Scientific Writer-Medical and Regulatory, Arkus Research Pvt. Ltd., Ahmedabad, India.

出版信息

Cardiovasc Hematol Agents Med Chem. 2023;21(1):10-19. doi: 10.2174/1871525720666220610160310.

Abstract

Diabetic patients with chronic kidney disease have a high risk of developing cardiovascular disease-related mortality and morbidity compared to non-diabetic chronic kidney disease patients. The Majority of chronic kidney disease patients with diabetes remain undiagnosed and have a higher incidence of cardiovascular comorbidities even when they do not progress to endstage renal failure. Both traditional cardiovascular risk factors and non-traditional cardiovascular risk factors are known to be present in a higher magnitude in diabetic patients with chronic kidney disease and are known to partially account for the increased incidence of cardiovascular disease compared to non-diabetic chronic kidney disease patients. Moreover, there is no definitive evidence for potential therapeutic treatment options for cardiovascular disease among diabetic patients with chronic kidney disease, as these patients have often not been included in major cardiovascular trials. Therefore, there is a need to recognize diabetic patients with chronic kidney disease patients having a high cardiovascular disease risk for definite and immediate medical attention at an individual patient level. Increased awareness, timely diagnosis, and intervention with respect to control these plays a pivotal role in avoiding undesirable cardiovascular disease events and lead to improved treatment outcomes among these patients. Further research is warranted to understand the risk factors for cardiovascular disease and to develop and implement preventive and treatment strategies to decrease the high morbidity and mortality among diabetic patients with chronic kidney disease. This review summarizes the available epidemiological data, and risk factors, discusses clinical presentations, and suggests prevention and management strategies for cardiovascular disease risk among diabetic patients with chronic kidney disease.

摘要

与非糖尿病慢性肾病患者相比,糖尿病合并慢性肾病患者发生心血管疾病相关死亡和发病的风险较高。大多数糖尿病慢性肾病患者仍未被诊断出来,即使未进展到终末期肾衰竭,其心血管合并症的发生率也较高。已知传统心血管危险因素和非传统心血管危险因素在糖尿病合并慢性肾病患者中更为常见,并且已知与非糖尿病慢性肾病患者相比,这些因素部分解释了心血管疾病发病率的增加。此外,对于糖尿病合并慢性肾病患者的心血管疾病潜在治疗选择,没有确凿的证据,因为这些患者通常未被纳入主要的心血管试验。因此,有必要在个体患者层面识别出具有高心血管疾病风险的糖尿病合并慢性肾病患者,以便进行明确和及时的医疗关注。提高对这些因素的认识、及时诊断并进行干预,对于避免不良心血管疾病事件以及改善这些患者的治疗效果起着关键作用。有必要进一步开展研究,以了解心血管疾病的危险因素,并制定和实施预防及治疗策略,以降低糖尿病合并慢性肾病患者的高发病率和死亡率。本综述总结了现有的流行病学数据和危险因素,讨论了临床表现,并提出了糖尿病合并慢性肾病患者心血管疾病风险的预防和管理策略。

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