[雙語翻譯]--醫(yī)學(xué)外文翻譯--血糖控制對2型糖尿病合并esrd患者預(yù)后的影響（英文）

1、Review ArticleThe impact of glycaemic control on outcomes in patients with end-stage renal disease and type 2 diabetesSOPHIA ZOUNGAS,1,2 PETER G KERR,3 MICHELLE LUI1 and HELENA J TEEDE1,21Diabetes Clinical Services and R

2、esearch Unit and 3Department of Nephrology, Monash University, Monash Medical Centre, and 2Jean Hailes Research Group, Monash Institute of Health Services Research, Monash Medical Centre, Clayton, Victoria, AustraliaSUMM

3、ARY: In Australia and New Zealand the prevalence and incidence of end-stage renal disease (ESRD) has increased. In Australia alone the financial burden is estimated to reach $500 million by 2007 (data from the National C

4、hronic Kidney Disease Strategy Workshop Report 2005). The leading cause of ESRD in Australia and New Zealand, and throughout the developed world, is type 2 diabetes, having overtaken glomerulonephritis in 2004.1 To date,

5、 management of patients with diabetes and ESRD has been, according to guidelines, given for patients without ESRD. This commentary raises three important emerging concerns in the clinical care of these patients: (i) the

6、lack of reliable tools to measure glycaemic control; (ii) limitations of the current data set supporting a relationship between outcome and glycaemic control in ESRD; and (iii) lack of studies examining the effect of int

7、ensive diabetes care and glucose control in patients with ESRD.KEY WORDS: end-stage renal disease, glycaemic control, outcomes, type-2-diabetes.THE EMERGING PROBLEM OF TYPE 2 DIABETES AND ESRDIn Australia and New Zealand

8、, approximately 740 people per million population receive renal replacement therapy and of these 420 people per million require dialysis therapy.2Over time a steady increase in these prevalence rates has been observed (F

9、ig. 1).2 Of those requiring renal replace- ment therapy, about one-third are new patients entering a dialysis programme. The most common cause of ESRD in Australia and New Zealand is diabetes. In 2005, diabetic nephropat

10、hy accounted for 32–41% of all new patients entering a dialysis programme.1 Similarly, of all patients requiring renal replacement therapy, 42% and 46% had diabetes, respec- tively. The majority of these patients (approx

11、imately 90%) have type 2 diabetes (Fig. 2).1 Of those about half are receiv- ing insulin therapy.Survival of the average dialysis patient is poor. The annual mortality rate for the Australian and New Zealand dialysis pop

12、ulation is 14.5 and 16.4 deaths per 100 patient- years, respectively.3 A large proportion of this, approxi- mately 65%, is attributed to cardiovascular disease (CVD) and infection (ANZDATA Registry report of 2005: cause

13、of death, Australia 49% CVD and 13% infection; New Zealand 49% CVD and 15% infection).3 Furthermore, the death rate due to CVD is 10- to 100-fold greater than that for age-matched populations (Fig. 3).3,4Over the last fi

14、ve decades, mortality due to CVD in the general population has declined by 50%5 and incident cardiovascular events have also declined in people with diabetes not complicated by ESRD.6 As reported by ANZ- DATA,3,7 in the

15、ESRD population, mortality due to CVD remains unchanged and unaffected by major advances in medical therapy (CVD mortality 1993 and 2005: 48.5% and 49%, respectively). In our own 5-year prospective study of incident card

16、io- vascular events in patients with ESRD, those with diabetes had a twofold greater risk of events and this risk was not abrogated by adjustment for age, gender, blood pressure, past history of CVD, smoking status and t

17、reatment with lipid lowering therapy or aspirin (unadjusted hazard ratio 2.41, P < 0.001, 95% CI 1.83–3.18; adjusted hazard ratio 1.86, P < 0.001, 95% CI 1.38–2.52; unpublished data, Fig. 4).Correspondence: Dr Soph

18、ia Zoungas, Diabetes Clinical Services and Research Unit, Southern Health, Monash Medical Centre, 246 Clayton Road, Clayton, Vic. 3168, Australia. Email: sophia.zoungas@med.monash.edu.au Accepted for publication 15 Octob

19、er 2007.© 2007 The Authors Journal compilation © 2007 Asian Pacific Society of NephrologyNEPHROLOGY 2008; 13, 124–127 doi:10.1111/j.1440-1797.2007.00901.xanaemia, blood transfusion and recombinant erythropoieti

20、n use may all impact on the accuracy of the HbA1C measure- ment. To this end, a Japanese study has recently reported that glycated albumin may provide a significantly better measure of glycaemic control in diabetic HD pa

21、tients com- pared with HbA1c because of the effects of anaemia and erythropoietin use.22 Moreover, it is unclear as to at whatpoint across the various stages of chronic kidney disease these methodological issues become c

22、linically relevant. As most of the effects of uraemia would be expected to lower HbA1c estimations, it may also be necessary to define a different ‘normal range’ for ESRD. Ultimately, available0.000.250.500.751.00Kaplan–

23、Meier survival probability72 55 28 0 Diabetes 243 171 106 0 No diabetes Number at risk0 2 4 6 Follow-up time (years)Fig. 4 Kaplan–Meier cardiovascular disease-free survival in patients with end-stage renal disease (ESRD)

24、 as compared with those with ESRD and diabetes (unpublished data). P < 0.001. --------- No diabetes; –––––– Diabetes.© ANZDATA RegistryCo-morbid Conditions at Entry to Program 2005 Number of Patients (% Patien

25、ts)Country Chronic Lung Disease Coronary Artery Disease Peripheral Vascular Disease Cerebro - Vascular Disease Smoking Australia =2210 Yes 276 (12%) 731 (33%) 392 (18%) 240 (11%) Current 254 (11%)

26、 Type I 86 (4%) Suspected 731 (33%) 156 (7%) 134 (6%) 60 (3%) Former 902 (41%) II -Ins Req 370 (17%) No 1873 (85%) 1323 (60%) 1684 (76%) 1910 (86%) Never 1054 (48%) II -Non Ins 464 (21%) No 1290 (58%

27、) New Zealand =436 Yes 61 (14%) 111 (25%) 64 (15%) 39 (9%) Current 70 (16%) Type I 14 (3%) Suspected 24 (6%) 51 (12%) 25 (6%) 12 (3%) Former 178 (41%) II -Ins Req 99 (23%) No 351 (80%) 274 (63%) 34

28、7 (79%) 385 (88%) Never 188 (43%) II -Non Ins 86 (20%) No 237 (54%) Diabetes (Including Diabetic Nephropathy ) nnFig. 2 Comorbid conditions at entry to dialysis programme.10.00120 40 60 80 100Age (years)0.010.1

29、0.20.4 0.620 40 60 80 100Mortality per yearFig. 3 Age-specific mortality rates of patients requiring renal replacement therapy as compared with the general population.32004 mortality rates: ·····