Risk Prediction and Management of Chronic Kidney Disease in People Living with Type 2 Diabetes Mellitus.

IF 6.8 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetes & Metabolism Journal Pub Date : 2024-03-01 Epub Date: 2024-01-26 DOI:10.4093/dmj.2023.0244
Ying-Guat Ooi, Tharsini Sarvanandan, Nicholas Ken Yoong Hee, Quan-Hziung Lim, Sharmila S Paramasivam, Jeyakantha Ratnasingam, Shireene R Vethakkan, Soo-Kun Lim, Lee-Ling Lim
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Abstract

People with type 2 diabetes mellitus have increased risk of chronic kidney disease and atherosclerotic cardiovascular disease. Improved care delivery and implementation of guideline-directed medical therapy have contributed to the declining incidence of atherosclerotic cardiovascular disease in high-income countries. By contrast, the global incidence of chronic kidney disease and associated mortality is either plateaued or increased, leading to escalating direct and indirect medical costs. Given limited resources, better risk stratification approaches to identify people at risk of rapid progression to end-stage kidney disease can reduce therapeutic inertia, facilitate timely interventions and identify the need for early nephrologist referral. Among people with chronic kidney disease G3a and beyond, the kidney failure risk equations (KFRE) have been externally validated and outperformed other risk prediction models. The KFRE can also guide the timing of preparation for kidney replacement therapy with improved healthcare resources planning and may prevent multiple complications and premature mortality among people with chronic kidney disease with and without type 2 diabetes mellitus. The present review summarizes the evidence of KFRE to date and call for future research to validate and evaluate its impact on cardiovascular and mortality outcomes, as well as healthcare resource utilization in multiethnic populations and different healthcare settings.

2 型糖尿病患者慢性肾病的风险预测与管理。
2 型糖尿病患者罹患慢性肾病和动脉粥样硬化性心血管疾病的风险增加。在高收入国家,医疗服务的改善和指导性医疗疗法的实施促使动脉粥样硬化性心血管疾病的发病率下降。相比之下,全球慢性肾脏病的发病率和相关死亡率要么趋于平稳,要么有所上升,导致直接和间接医疗费用不断攀升。在资源有限的情况下,采用更好的风险分层方法来识别有可能迅速发展为终末期肾病的人群,可以减少治疗惰性,促进及时干预,并确定早期肾病转诊的需要。在 G3a 及以上慢性肾脏病患者中,肾衰竭风险方程(KFRE)已通过外部验证,并优于其他风险预测模型。KFRE 还能指导肾脏替代治疗的准备时间,改善医疗资源规划,并可预防伴有或不伴有 2 型糖尿病的慢性肾脏病患者出现多种并发症和过早死亡。本综述总结了迄今为止有关 KFRE 的证据,并呼吁今后开展研究,以验证和评估 KFRE 对心血管和死亡率结果的影响,以及在多种族人群和不同医疗环境中对医疗资源利用的影响。
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来源期刊
Diabetes & Metabolism Journal
Diabetes & Metabolism Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
10.40
自引率
6.80%
发文量
92
审稿时长
52 weeks
期刊介绍: The aims of the Diabetes & Metabolism Journal are to contribute to the cure of and education about diabetes mellitus, and the advancement of diabetology through the sharing of scientific information on the latest developments in diabetology among members of the Korean Diabetes Association and other international societies. The Journal publishes articles on basic and clinical studies, focusing on areas such as metabolism, epidemiology, pathogenesis, complications, and treatments relevant to diabetes mellitus. It also publishes articles covering obesity and cardiovascular disease. Articles on translational research and timely issues including ubiquitous care or new technology in the management of diabetes and metabolic disorders are welcome. In addition, genome research, meta-analysis, and randomized controlled studies are welcome for publication. The editorial board invites articles from international research or clinical study groups. Publication is determined by the editors and peer reviewers, who are experts in their specific fields of diabetology.
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