Iperurisemia ak dyabèt melitu lè yo rive ansanm gen pi gwo risk pase poukont yo sou tout kòz mòtalite ak maladi ren fen nan pasyan ki gen maladi ren kwonik Ⅲ

Résumé

ZÈB TRADISYONÈL ÒGANIC POU SANTE REN

Entwodiksyon

Maladi ren kwonik (CKD)se yon fado sante piblik atravè lemond akòz popilasyon pasyan ki rapidman elaji li yo, gwo risk pou pwogresyon nanmaladi ren fen etap(ESKD), ak move pronostik morbidite ak mòtalite [1, 2]. Mòtalite prensipal pasyan sa yo se lanmò ki gen rapò ak kadyovaskilè (CV). Avèk pwogresyon CKD, rezilta CV yo vin pi mal, tankou lanmò CV, re-enfaktis, ensifizans kadyak konjestif, konjesyon serebral, ak reanimasyon [3]. Kòz ki pi komen nan CKD se dyabèt melitus (DM) [4]. Rapò Pwogram Edikasyon Nasyonal Kolestewòl 2002 la te deziyen DM kòm yon ekivalan risk pou maladi kè kardyovaskulèr, epi DM plase nan kategori ki pi gwo risk [5]. Anplis de sa, DM ak CKD yo tou de pisan faktè risk endepandan pou evènman CV ak pwogresyon nan ESKD [6, 7]. DM gen yon gwo fado nan epesman entim ki gen rapò ak ateroskleroz ak CKD tou lakòz kalsifikasyon medyal [8]. Se poutèt sa, pasyan ki gen tou de kondisyon an menm tan an Se poutèt sa, yo gen gwo risk pou yo gen evènman negatif epi yo ta fini ak rezilta pasyan pòv yo.

Nivo serik asid urik (UA) se tou yon faktè risk pou maladi ren [9], maladi kadyovaskilè (CVD) [10-12], ak ateroskleroz [13]. Serum UA se yon faktè risk endepandan pou CKD, menm nan moun ki pa gen dyabèt [14, 15]. De gwo etid epidemyolojik te montre ke UA se yon gwo prediktè nan ensidans maladi ren [15, 16]. Anplis de sa, ipèrisemi souvan répandus nan pasyan CKD epi li asosye ak yon ensidans ki pi wo nan ESKD [16]. Plizyè etid te montre ke UA poukont predi devlopman nan tip 2 DM [17-19] ak pwogresyon nan CKD [20]. Pou apeprè 20 ane, UA te konnen yo dwe yon faktè risk potansyèl pou CKD ak CVD ak enplikasyon patolojik [21, 22, 23]. Bay entèraksyon konplèks ant ipèrisemi, DM, ak pwogresyon CKD, nou enterese nan eksplore entèraksyon yo konplike konsènan rezilta ren ak pasyan yo. Isit la, nou vize pou mennen ankèt sou efè DM ak hyperuricemia sou mòtalite pasyan yo ak devlopman ESKD nan yon gwo kòwòt pasyan CKD.

Metòd

Etid kowòt ak definisyon

In this retrospective cohort study, we enrolled 4380 patients with CKD from the outpatient clinic of the nephrology department, Taichung Veterans General Hospital (TVGH), Taiwan. Our hospital, a medical center with 1500 beds, is the referral hospital for the critically ill and difficult cases in central Taiwan. During the past 30 years, the CKD care program treated >10,000 pasyan ekstèn ki gen CKD. CKD te defini kòm yon estimasyon pousantaj filtraj Glo macular (eGFR)<60ml/min/1.73m2 for > 3 months irrespective of the cause. The eGFR equaltion was from Modification of Diet in Renal Disease (ml/min/1.732m2 ) [24]. DM was confrmed according to the diagnosis of medical records. Hyperuricemia was defined as UA levels >7.0mg/dl for men, or>6.0mg/dl pou fanm [21, 25]. Done laboratwa sa yo te mezire nan enstiti nou an (TVGH).

Koleksyon done

We enrolled patients (> 20 years old) with CKD 3–5 from 2007 to 2013 in this study. After follow-up (2.5 years of mean duration) (end data of this study: 31-December-2015), the outcomes were analyzed by mortality and participants received regular dialysis for at least 3 months or renal transplantation (ESKD). Their baseline variables were collected from medical records, including age, gender, stages of CKD, systolic blood pressure (SBP) (baseline and 1 year mean value), and diastolic blood pressure (DBP) (baseline and 1 year mean value), history of coronary artery disease, history of ever smoker, UA (baseline and 1 year mean value), baseline total cholesterol, usage of statin and usage of an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB). The stage of CKD was based on the baseline renal function (the frst laboratory data during the recruitment period). We chose the Modification of Diet in Renal Disease (MDRD) formula, instead of the Cockcroft and Gault formula, due to its superior accuracy in diabetic patients with impaired renal functions [26]. Although CKD-EPI (Epidemiology Collaboration) is more accurate than the MDRD equation for subjects with eGFR >60ml/min/1.73 m2, fòmil MDRD se youn ki aplike nan baz done nasyonal Taiwan pou evalye inisyasyon dyaliz ak prévalence CKD [27-29].

Apwobasyon etik ak konsantman pou patisipe

Analiz estatistik

Done yo te prezante kòm devyasyon estanda mwayèn pou varyab kontinyèl ak pwopòsyon pou varyab kategori cal. Yo te itilize yon tès t endepandan de ke

modèl danje, ajiste pou kovaryè enpòtan yo konnen ki asosye ak prediktè yo ak rezilta enterè yo (ajiste pou laj, sèks, janm fimen, etap CKD, 1 ane SBP vle di, itilizasyon statin, itilizasyon dwòg ipèrisemi, ak itilizasyon ACEi/ARB.) . Anplis de sa, depi mòtalite a se te yon evènman konpetisyon ak dyaliz, yo te itilize yon modèl pwolonje pwopòsyonèl danje Cox pou kalkile rapò danje sub-distribisyon (SHR) dyaliz kòm yon tès sansiblite [30]. Nou menm tou nou analize efè DM ak hyper uricemia sou tout kòz mòtalite ak ESKD selon diferan etap nan CKD. Yo te mete siyifikasyon estatistik nan p< 0.05. Statistical analyses were all carried out by using SPSS 22.0 (SPCC, Chicago, Illinois). The extended Cox proportional hazards model was analyzed by SAS software (version 9.4; SAS Institute, Inc., Cary, NC, USA).