QUẢN LÝ ĐỒNG THỜI TĂNG HUYẾT ÁP TĂNG URIC ACID MÁU trong ĐÁI THÁO ĐƯỜNG

QUẢN LÝ ĐỒNG THỜI TĂNG HUYẾT ÁP & TĂNG URIC ACID MÁU ĐÁI THÁO ĐƯỜNG • • Prof Phạm Văn Bùi • BV Nguyễn Tri Phương • ĐH YK Phạm Ngọc Thạch • GS Thỉnh giảng ĐH Liège , Belgium • Chủ tịch Hội Thận-Lọc Máu, Tp HCM ACID URIC LÀ YẾU TỐ NGUY CƠ TIM MẠCH & THẬN ĐƯỢC GHI NHẬN ĐẦU TIÊN TRONG LỊCH SỬ Does gouty nephropathy exist, & it is more important than we think?,     25% gout subjects → kidney failure, 50% →↓kidney function, and # all had kidney disease at autopsy Hyperuricemia → cause & accelerate CKD via hemodynamic & cellular effects of soluble uric acid on the glomeruli, vasculature, & tubules  Urate crystal deposition in the kidney could also be contributing to kidney injury  DECT scanning: urate deposits can occur in extra-articular tissues of subjects with gout, including the aorta and coronary arteries Federica Piani & Richard J Johnson Kidney International(2021) 99, 31-33 Bardin T Kidney International(2021) 99: 218-220 URIC ACID & T2DM Phân tích gộp 11N/C: [Uric Acid] ↑1mg/dL→ ↑ 17% nguy T2DM Kodama S et al(2019) Diabetic Care URIC ACID & CVD   UA: yếu tố nguy độc lập cho biến cố tim mạch: bệnh mạch vành, mạch máu não, suy tim sung huyết ↑[UA] 1mg/dL→  † tim mạch: 20%  † toàn thể: 9% Gaubert m et al(2018): Purinergic Signals Zuo T et al(2016) BMC Cardiovasc Disord CVD More Common in Patients With Hyperuricemia, Gout Study (Renal Associates, LLC in Columbus, Georgia) 513 pts with hyperuricemia (257 pts) or gout (256 pts) and 613 practice pts:  Prevalence of CVD events was 32.3% / hyperuricemia + gout pts (study group) compared with 17.6% among practice pts  Among patients with CKD stage 3, the prevalence of CVD events was about 32% in the study group compared with 13% of practice patients Alappan UD, Alappan R Symptomatic hyperuricemia (gout) patients have higher occurrence of cardiovascular and coronary artery disease.Data presented at the live virtual 2020 National Kidney Foundation Spring Clinical Meetings held March 257 28 ePoster 197 Relationship between uric acid and blood pressure (Lee et al Clinical Hypertension (2015) 21:14 DOI 10.1186/s40885-015-0022-9) High prevalence and low awareness of hyperuricemia in hypertensive patients Yang Zhang ET AL(2022) BMC Cardiovascular Disorders 22(1) DOI:10.1186/s12872-02102427-2 BP, Uric Acid Linked in Adolescents • National Health and Nutrition Examination Survey: 6,036 individuals aged 12-17 years • Each 0.1 mg/dL increment in uric acid is associated with a 38% increased odds of having elevated BP • The association between uric acid and BP persisted after adjusting for body mass index • It remains unclear if uric acid is merely a marker or is involved in the causal pathway leading to HTN Lauren F L et al Hypertension (2017) RENAAL Tiêu chí phụ Giảm protein niệu & tỷ lệ nhập viện lần đầu suy tim có ý nghĩa thống kê Median % change 40 Tỷ lệ nhập viện lần đầu suy tim 20 -35% –20 -32% –40 P = 0.005 p