高血压英文ppt精品课件worldkidney

WHY WORLD KIDNEY DAY?,WORLD KIDNEY DAY (1),PURPOSE:,World Kidney Day was established to increase awareness of the need for detection programs for CKD & to improve prevention & treatment of CKD. 2.The motto of World Kidney Day: Kidney Disease is Common, Harmful and Treatable.,About 20 Million People With Chronic Kidney Disease (CKD) in the United States and 20 Million More at Risk Estimates Suggest That About 10 Percent of Adult Patients Worldwide May Have CKD,Dialysis Mortality: 20% General Population vs ESRD Dialysis Patients,RN Foley, PS Parfrey, and MJ Sarnak; Clinical epidemiology of cardiovascular disease in chronic renal disease AJKD, 1998 32(5):S112-S119,Most People with CKD will Die Prematurely from their Increased Risk of Cardiovascular and Cerebrovascular Disease Before they Develop End-Stage Kidney Failure,WHY WORLD KIDNEY DAY?,Chronic, non-communicable diseases (i.e. CVD, HTN, DM and CKD) have now replaced communicable diseases as the LEADING THREAT to public health & health budgets worldwide Deaths Attributed to infectious diseases will decline by 3% over the next decade Attributed to chronic diseases will increase by 17% over the same time frame,Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD),Diabetes Is the Most Common Primary Diagnosis in Patients With Kidney Failure,ESRD = end-stage renal disease. USRDS 2005 Annual Data Report. The data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government. Available at: . Accessed December 6, 2005.,Diabetes 50%,Hypertension 27%,Glomerulonephritis 13%,Other 10%,Primary Diagnoses for Patients Who Start Dialysis,United States Renal Data System (USRDS) 2005 Annual Data Report WWW.USRDS.ORG,Potentially Preventable Causes of CKD,Cause Responsible for % of CKD 1.Diabetes Mellitus/Obesity 45% 2.Hypertension 27% _ Total Potentially Preventable Cases of CKD 72% NOTE: Since both of these disorders are in large part related to unhealthy nutritional intake and/or physical inactivity, these diseases and the consequent development of CKD and ESKD are potentially largely preventable and reversible.,DEFINITION OF OBESITY,Overweight: BMI 25.0 -29.0 kg/m2 Obese: BMI 30 kg/m2 Morbidly Obese: 35kg/m2 Abdominal Obesity: Waist circumference 102 cm in men; 88 cm in women,Hill, Endocrine Reviews 2006;27:750-761,HSU et al. Ann Int Med 2006;144:21,OBESITY RISK FOR ADVANCED CKD,BMI 25 at 20 years old OR for Incidence of Advanced CKD Stratified by Comorbidity No Diabetes 2.4( CI: 1.6-3.6) No Hypertension 3.6 (1.8-7.1) No Diabetes or Hypertension 3.0 (1.4-6.4) Stratified by Type of CKD Diabetic Nephropathy 5.2 (3.2-8.4) Nephrosclerosis 3.0 (1.6-5.5) Glomerulosclerosis 3.0 (1.8-4.9) Other 2.1 (1.2-3.6) Ejerblad et al JASN 2006;17:1695-1702,Kramer Contrib Nephrology 2006;151:1-18,Iseki Contrib Nephrology 2006;42-56,Kelley et al, Int J Obesity 2008;32:1431-1437,Percentage of population that is overweight,Percentage of population that is obese (BMI30kg/m2,(BMI 25-29kg/m2),Challenges of CKD Management problems, enormous everywhere, are particularly great, even overwhelming, in developing countries: 1. Little awareness of CKD or its consequences 2. Few financial resources for prevention, detection or treatment 3. Little expertise 4. High prevalence of CKD,Today There are Many Safe and Effective Treatments That Prevent or Slow the Progression of Chronic Kidney Disease,Simple Methods for Detection of CKD 1. Urine Albumin, including Microalbumin (indicator of kidney disease especially of small blood vessels in kidney) 2. Serum Creatinine (indicator of kidney function) 3. Blood Pressure,What Can WKD Do (1)?,1. Advertise/Educate i. The public-at large ii. National, regional and local governments, insurers and other health related organizations (eg, the pharmaceutical industry) iii. Health care professionals (There is abundant evidence that medical care is suboptimal nationally, even when financial resources are not a limiting factor).,What Can WKD Do (2)?,2. Advocate i. With National, State and Local Governments for Better Kidney Disease: - Education - Prevention - Detection - Treatment ii. With Other Major Organizations; e.g., Insurance Agencies, Large Health Care Providers, Universities, etc.,What Can Be Done (2)?,2. Conduct Detection and Treatment Programs i. Particularly for high risk groups. ii. Employ inexpensive methods of detection and treatment (Experience of Dr. Manis from Chennai, consider using non-physicians where possible). iii. Collaboration with other like-minded organizations will increase efficiency and effectiveness especially for a nation as populous and with as many volunteer health organizations as India.,What Can Be Done (4)?,4. Ultimately, the costs of prevention, detection and treatment programs nationally will require resources that can only be provided by such national or regional organizations as governments or other third party insurers But this is for the future.,WORLD KIDNEY DAY,A SUCCESS STORY:,There has been an overwhelming response around the world to World Kidney Day.,WKD Successes (1),Outstanding response from around the world: 45 participating countries - 2006 63 participating countries - 2007 90 participating countries & territories 2008 Over 100 participating countries & territories -2009,WKD Successes (2),Participating Countries from Albania to Zimbabwe In many countries, activities in many different places Participating organizations included: societies, foundations, universities, colleges, hospitals associations, trusts and individuals Local activities focused on raising awareness across all key audiences: Public-at -large, Government ministers and Health Officials, Physicians and Allied Health Professionals,World Kidney Day Los Angeles 2010 (2),Many Southern California Organizations joined together for this event (continued) March, 2010 4. Kidney Disease Lectures at Scheduled Hospital Conferences, Universities - Academic Nephrologists,World Kidney Day Los Angeles 2010 (1),Many Southern California Organizations joined together for this event March 7, 2010 1. Polycystic Kidney Disease / KidneyWise Walk March 11, 2010 2. Minority community education program and focus groups Drew Postgraduate Medical School, Community Organizations 3. KEEP Dectetion Program National Kidney Foundation,World Kidney Day Los Angeles 2010 (3),Many Southern California Organizations joined together for this event (continued) March 13, 2009 5. CKD Management Training for MDs, RNs, General Internists, Family Practitioners, Nurse Practitioners and Specialists, Case Managers Kaiser Permanente Health Care System and Foundation, Los Angeles County Department of Health Services,World Kidney Day Los Angeles 2010 (4),Many Southern California Organizations joined together for this event (continued) March, 2008, 2009 And 2010 6. Innumerable planning meetings and individual activities By representatives of all of the above organizations and entities 7. In Washington and elsewhere, meeting with government officials, editorials, the media and many many other activities,March 11, 2010,World,Kidney,Day,Interconnections Between Obesity, Diabetes Mellitus (DM), High Blood Pressure, and Chronic Kidney Disease (CKD) Relationships between Obesity, Diabetes & CKD: i. Obesity predisposes to both Diabetes & CKD ii. Diabetes is the most common cause of end-stage CKD that requires chronic dialysis treatments or renal transplantation iii. Roughly one-third of people with Diabetes will develop CKD,Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD) Relationships between Obesity, Diabetes & CKD: (continued) iv. Diabetes is easy to detect, can be prevented in most cases, and can usually be treated effectively in most cases.,Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure and Chronic Kidney Disease (CKD) Relationships between Obesity, Diabetes & CKD : v. Tight glucose control in DM appears to reduce the risk for CKD. vi. Blood pressure control reduces the harmful complications of DM. vii. DM is easy to detect, and in most cases, it can be prevented and usually treated effectively.,Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD) Relationships between CKD & high blood pressure: i. High blood pressure, like chronic kidney disease (CKD), is often silent and dangerous. ii. High blood pressure causes CKD. iii. CKD causes High blood pressure. iv. Both CKD and Hogh blood pressure are common and treatable.,Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD) Relationships between Obesity, Diabetes, CKD, High blood pressure versus Vascular Disease: 1. Each of the above four conditions increase the risk for Cardiovascular and Cerebrovascular Disease. 2. This risk is often markedly increased. 3. Together these 4 diseases (Obesity, Diabetes, CKD and high blood pressure) cause a large percentage of the illnesses and deaths in the Developed and the Developing World.,Interconnections Between Obesity, Diabetes Mellitus, High Blood Pressure, and Chronic Kidney Disease (CKD) What can We do to Prevent and Treat these Related Diseases and Their Harmful Effects?,Diabetes: Tight Glucose & Blood Pressure Control and CV Outcomes,Stroke,Any Diabetic Endpoint,DM Deaths,Microvascular Complications,-50,-40,-30,-20,-10,0,% Reduction In Relative Risk,Tight Glucose Control (Goal 6.0 mmol/l or 108 mg/dL),Tight BP Control (Average 144/82 mmHg),32%,37%,10%,32%,12%,24%,5%,44%,*,*,*,*,*P 0.05 compared to tight glucose control,Bakris GL, et al. Am J Kidney Dis. 2000;36(3):646-661.,Suggested Goals for CKD Patients esp. with Diabetes and High Blood Pressure,Lifestyle modifications (no obesity, regular exercise) BP 130/80 mmHg or lower, esp in diabetes or proteinuria) Maximal reduction of proteinuria (1 g/d) Multiple BP lowering meds(3-4 meds or more, if needed) ACEIs, ARBs, Diuretics, Beta-Blockers, Non-Dihydropyridine-CCBs HbA1c at 7% (in diabetics) Dietary protein restriction (0.6 - 0.8 kg/d) Dietary sodium restriction (2-3 g/d sodium) Lipid-lowering therapy (diet, statins),What Can Be Done (3)?,3. New Direction: We are beginning to join with other disease focused groups and world health days that relate to kidney disease (for example, World Hypertension Day, possibly in the future, World Diabetes Day).,World Kidney Day-Plans For 2009(2),2. Collaboration with World Hypertension Day. i. Share messages on websites, in printed messages? ii. Place links on respective websites? iii. Inaugurate combined programs in selected circumstances(2009 WKD will add a HTN focus). 3. Basic Principal: A message has the greatest impact when it is repeated many times and in different ways or by different groups.,World Kidney Day-Plans For 2009(3),i. It follows that we might all come closer to achieving our respective goals if Heart, Diabetes and Stroke join in this linkage effort with WHD and WKD. 4. Role for the Vascular Alliance? i. Coordinate such linkage efforts? ii. Facilitate the liais