医药卫生糖尿病肾病新观点课件.pptVIP

*  * A representative study to illustrate the relationship between CKD risk and prehypertension comes from the Multiple Risk Factor Intervention Trial. A clear relationship between the level of systolic and diastolic pressure over a 16-year follow-up period provided important information in the context of end-stage renal disease (ESRD) incidence. Indeed, the increase in risk was noticeable across the prehypertensive BP range with a 43.6% higher likelihood of progressing to ESRD if it was in the 130–139/85–89 mm Hg range versus the lower range (Figure 1). Overall, the relative risk (RR) for the progression to ESRD related with any cause in 73,798 men, with baseline BPs of 130/80 and 140/90 mm Hg, was almost double, compared with optimal BP (RR 1.9, 95% confidence interval (CI) 1.4–2.7, P0.001, * Setting: The Third National Health and Nutrition Examination Survey. Patients: Participants 20 years of age or older were studied in the chronic kidney disease ( n ? 6217) and microalbuminuria (n ? 6125) analyses. Measurements: The metabolic syndrome was defined as the presence of 3 or more of the following risk factors: elevated blood pressure, low high-density lipoprotein cholesterol level, high triglyceride level, elevated glucose level, and abdominal obesity. Chronic kidney disease was defined as a glomerular filtration rate less than 60 mL/min per 1.73 m2, and microalbuminuria was defined as a urinary albumin¨Ccreatinine ratio of 30 to 300 mg/g. Results: The multivariate-adjusted odds ratios of chronic kidney disease and microalbuminuria in participants with the metabolic syndrome compared with participants without the metabolic syndrome were 2.60 (95% CI, 1.68 to 4.03) and 1.89 (CI, 1.34 to 2.67), respectively. Compared with participants with 0 or 1 component of the metabolic syndrome, participants with 2, 3, 4, and 5 components of chronic kidney disease had multivariate-adjusted odds ratios of 2.21 (CI, 1.16 to 4.24), 3.38 (CI, 1.48 to 7.69), 4.23 (CI, 2.06 to 8.63),