2型糖尿病的患病率越来越高。预期寿命以心血管风险为主,这是这些患者死亡的主要原因。多达三分之一的糖尿病患者将发展与微血管病相关的糖尿病肾病。肾功能损害进一步增加心血管风险。降低心血管发病率和死亡率是一个重大的公共卫生问题,以及早期预防和管理慢性肾脏病(CKD)。良好的血糖控制可预防该疾病的微血管并发症(视网膜病变,肾病,等。)和,最近通过对VADT队列的长期监测认识到,预防心血管并发症。控制血压和血脂异常在初级或二级心血管预防中至关重要。此外,肾素-血管紧张素系统的阻滞剂减缓了MRC的进展。患有慢性肾脏疾病(CKD)的老年患者构成了肾脏科医师日常患者库的另一个增长群体。特别是对于患有合并症的高龄患者,可能会出现倾向于保守治疗而不是开始或进行透析的问题。老年透析患者的生存率和生活质量确实不一定较好,并发症可能最终导致停药,偶尔会有一种固执的感觉。创建预后评分是帮助决策过程的有用工具。然而,与患者及其家人对话,以及多学科合作仍然是确定最合适护理的基础。
Type 2 diabetes has an increasing prevalence. Life expectancy is dominated by cardiovascular risk, which is the leading cause of death in these patients. Up to one third of diabetic patients will develop diabetic nephropathy related to micro-angiopathy. Renal impairment further increases cardiovascular risk. Reducing cardiovascular morbidity and mortality is a major public health issue, as well as early preventing and managing chronic kidney disease (CKD). Good glycemic control prevents the micro-vascular complications of the disease (retinopathy, nephropathy, etc.) and, more recently recognized through prolonged monitoring of the VADT cohort, prevents cardiovascular complications. Control of blood pressure and dyslipidemia are essential in primary or secondary cardiovascular prevention. In addition, the blockers of the renin-angiotensin system slow down the progression of the MRC. Elderly patients with chronic kidney disease (CKD) form another growing group of the nephrologist daily patient pool. Especially for very elderly patients with comorbidities, the question of favoring conservative treatment rather than starting or pursuing dialysis may arise. Survival and quality of life are indeed not necessarily better in elderly patients undergoing dialysis, complications can occur eventually leading to discontinuation, and are occasionally associated with a feeling of stubbornness. Creation of prognostic score is a useful tool to help the decision-making process. However, dialogue with the patient and his/her family, as well as multidisciplinary collaboration remain fundamentals to determine the most suitable care.