4 RLLM TREN BENH THAN MAN DO đtđ BS LE HOAI NAM final

Kiểm soát Rối loạn mỡ máu bệnh nhân bệnh thận mạn đái tháo đường ThS BS Lê Hoài Nam Đai Học Y Dược Tp.HCM Global Burden of Diabetes Global Burden of CKD 1990-2016 Diabetes is the most common cause of end-stage renal disease United States Renal Data System Annual Report, 2015 KDIGO Diabetes Guideline Webinar Looking at the Latest Evidence Why Is CKD Strongly Associated With Cardiovascular Morbidity and Mortality? Fibrinolysis Dyslipidemia LPL/↓HDL/↑TG/↑Lp(a) Coagulopathy Unique Vascular Calcification Ca/PO4/PTH Platelet Dysfunction Diabetes as a Central Driver “Vasculopathy of Diabetes” Inflammation Oxidative stress Oxidized LDL-C Hyperhomocystinemia “Thiol Hypothesis” CKD-related Vascular Pathobiology Cardiovascular Stress of ESRD/Dialysis Chronic Volume Overload/Diminished Response to Natriuretic Peptides Endothelin/Nitric Oxide Balance Disrupted SNS Hyperactivation Abnormal Structural Proteins/Protein Turnover “Advanced Glycation End-Products” RAS Hyperactivation Anemia Erythropoietin Deficiency Adverse LV Remodeling Renin-Angiotensin System Ca, calcium; HDL, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein (a); LPL, lipoprotein lipase; LV, left ventricle; PO4, phosphate; PTH, parathyroid hormone; RAS, renin angiotensin system; SNS, sympathetic nervous system; TG, triglycerides Reprinted from Journal of the American College of Cardiology, 41, McCullough PA, Why Is Chronic Kidney Disease the “Spoiler” for Cardiovascular Outcomes?, 725–728, Copyright (2003), with permission from Elsevier Dyslipidemia in diabetic nephropathy Role of dyslipidemia in diabetic nephropathy Dyslipidemia promotes the development of diabetic nephropathy Abnormal lipoprotein metabolism is accelerated in diabetic nephropathy that causes further renal injury, leading to ESRD as well as cardiovascular (CV) events Natural course of CKD 5-year follow-up of CKD patients in the Kaiser database Endpoint Stage (eGFR 60–89, proteinuria) n=1741 Stage (eGFR 30–59) N=11 278 Stage (eGFR 15–29) N=777 Progression to renal replacement therapy 1.1% 1.3% 19.9% Death 19.5% 24.3% 45.7% Keith DS, et al Arch Intern Med 2004;164:659–663 Association of eGFR with All-Cause and CV Mortality in General Population Cohorts: a Collaborative Meta-analysis Chronic Kidney Disease Prognosis Consortium All-cause mortality versus eGFR 0.5 Cardiovascular mortality versus eGFR HR (95% CI) eGFR