На сегодняшний день распространенность хронической болезни почек (ХБП) обусловливает значительную нагрузку на общественное здравоохранение во всем мире. Сахарный диабет (СД) 2 типа является наиболее частой причиной терминальной стадии хронической болезнью почек. На сегодняшний день доля пациентов, находящихся на заместительной почечной терапии по сравнению с началом 2000-х, значительно увеличились с соответствующим увеличением доли пациентов с ХБП в терминальной стадии (С5), связанных с диабетической нефропатией.
Пациенты с ХБП в терминальной стадии (С5) имеют более высокий уровень риска развития сердечно-сосудистых осложнений и смертности, чем можно было бы предсказать с помощью шкал SCORE и исследование Framingham для оценки сердечно-сосудистого риска, основанной на «традиционных» факторах риска, таких как пол, возраст, артериальная гипертензия, курение, уровень общего холестерина и липопротеидов высокой плотности, наличие сахарного диабета, ожирения. У пациентов с ХБП в терминальной стадии (С5) имеются дополнительные факторы риска сердечно-сосудистых осложнений, обусловленные уремическим статусом и самой заместительной терапией. Эти факторы включают анемию, нарушение фосфорно-кальциевого обмена, белково-энергетическую недостаточность и гиперволемию.
Цель
Определить насколько велики риски сердечно-сосудистых осложнений у пациентов с диабетической нефропатией находящихся на гемодиализе по сравнению с пациентами без диабетической нефропатии находящихся на гемодиализе.
РССО и смертность остаются чрезвычайно распространенными у пациентов СД 2 типа находящихся на гемодиализе. Ожидается, что всемирное увеличение сердечно-сосудистых осложнений при терминальной стадии ХБП (С5) возрастет, учитывая старение населения, рост распространенности СД и артериальной гипертензии среди населения в целом.
Будущие исследования могут сосредоточиться на влиянии оптимизации назначения гемодиализа с уделением особого внимания управлению объемом и электролитами, потенциальной роли новых антикоагулянтов у пациентов с мерцательной аритмией и роли дефибрилляторов.
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