高血压英文课件WORLDKIDNEY

.WHY WORLD KIDNEY DAY?.WHY WORLD KIDNEY DAY?.WORLD KIDNEY DAY(1)PURPOSE:1.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.WORLD KIDNEY DAY(1)PURPOSE:WoAbout20MillionPeopleWithChronicKidneyDisease(CKD)intheUnitedStatesand20MillionMoreatRiskEstimatesSuggestThatAbout10PercentofAdultPatientsWorldwideMayHaveCKD.About 20 Million People With CDialysis Mortality:20%General Population vs ESRD Dialysis PatientsRNFoley,PSParfrey,andMJSarnak;ClinicalepidemiologyofcardiovasculardiseaseinchronicrenaldiseaseAJKD,199832(5):S112-S119.Dialysis Mortality:20%Gener.MostPeoplewithCKDwillDiePrematurelyfromtheirIncreasedRiskofCardiovascularandCerebrovascularDiseaseBeforetheyDevelopEnd-StageKidneyFailure.Most People with CKD will Die InterconnectionsBetweenObesity,DiabetesMellitus,HighBloodPressure,andChronicKidneyDisease(CKD).Interconnections Between ObesiDiabetesIstheMostCommonPrimaryDiagnosisinPatientsWithKidneyFailureESRD=end-stagerenaldisease.USRDS2005AnnualDataReport.ThedatareportedherehavebeensuppliedbytheUSRDS.Theinterpretationandreportingofthesedataaretheresponsibilityoftheauthor(s)andinnowayshouldbeseenasanofficialpolicyorinterpretationoftheU.S.government.Availableat:www.usrds.org.AccessedDecember6,2005.HypertensionGlomerulonephritisOther20%45%27%8%Diabetes350300250200150100500IncidentDialysis(2003:100,499)YearNumberofPatients(thousands)350300250200150100500PrevalentDialysis(2003:324,826)PrevalentTransplant(2003:128,131)8890929496980002.Diabetes Is the Most Common PrDiabetes50%Hypertension27%Glomerulonephritis13%Other10%PrimaryDiagnosesforPatientsWhoStartDialysisUnited States Renal Data System(USRDS)2005 Annual Data Report WWW.USRDS.ORG.DiabetesHypertensionGlomerulonDEFINITION OF OBESITY1.Overweight:BMI 25.0-29.0 kg/m22.Obese:BMI 30 kg/m23.Morbidly Obese:35kg/m24.Abdominal Obesity:Waist circumference 102 cm in men;88 cm in women.DEFINITION OF OBESITYOverweighHill,EndocrineReviews2006;27:750-761.Hill,Endocrine Reviews 2006;2HSUetal.AnnIntMed2006;144:21.HSU et al.Ann Int Med 2006;14 OBESITY RISK FOR ADVANCED CKDBMI 25 at 20 years old OR for Incidence of Advanced CKDStratified 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 .OBESITY RISK FOR ADVANCED CKDIsekiContribNephrology2006;42-56.Iseki Contrib Nephrology 2006;Kelleyetal,IntJObesity2008;32:1431-1437PercentageofpopulationthatisoverweightPercentageofpopulationthatisobese(BMI30kg/m2(BMI25-29kg/m2).Kelley et al,Int J Obesity 20 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 expertise4.High prevalence of CKD.Challenges of CKD ManagTodayThereareManySafeandEffectiveTreatmentsThatPreventorSlowtheProgressionofChronicKidneyDisease.Today There are Many Safe and SimpleMethodsforDetectionofCKD1.UrineAlbumin,includingMicroalbumin(indicatorofkidneydiseaseespeciallyofsmallbloodvesselsinkidney)2.SerumCreatinine(indicatorofkidneyfunction)3.BloodPressure.Simple Methods for WhatCanWKDDo(1)?1.Advertise/Educatei.Thepublic-atlargeii.National,regionalandlocalgovernments,insurersandotherhealthrelatedorganizations(eg,thepharmaceuticalindustry)iii.Healthcareprofessionals(Thereisabundantevidencethatmedicalcareissuboptimalnationally,evenwhenfinancialresourcesarenotalimitingfactor).What Can WKD Do(1)?1.AdvertWhatCanWKDDo(2)?2.Advocatei.WithNational,StateandLocalGovernmentsforBetterKidneyDisease:-Education-Prevention-Detection-Treatmentii.WithOtherMajorOrganizations;e.g.,InsuranceAgencies,LargeHealthCareProviders,Universities,etc.What Can WKD Do(2)?2.AdvocaWhatCanBeDone(2)?2.ConductDetectionandTreatmentProgramsi.Particularlyforhighriskgroups.ii.Employinexpensivemethodsofdetectionandtreatment(ExperienceofDr.ManisfromChennai,considerusingnon-physicianswherepossible).iii.Collaborationwithotherlike-mindedorganizationswillincreaseefficiencyandeffectivenessespeciallyforanationaspopulousandwithasmanyvolunteerhealthorganizationsasIndia.What Can Be Done(2)?2.ConduWhatCanBeDone(4)?4.Ultimately,thecostsofprevention,detectionandtreatmentprogramsnationallywillrequireresourcesthatcanonlybeprovidedbysuchnationalorregionalorganizationsasgovernmentsorotherthirdpartyinsurersButthisisforthefuture.What Can Be Done(4)?4.UltimWORLD KIDNEY DAY A SUCCESS STORY:There has been an overwhelming response around the world to World Kidney Day.WORLD KIDNEY DAY A SUCCESS STOWKDSuccesses(1)Outstandingresponsefromaroundtheworld:45participatingcountries-200663participatingcountries-200790participatingcountries&territories2008Over100participatingcountries&territories-2009.WKD Successes(1)Outstanding rWKDSuccesses(2)ParticipatingCountriesfromAlbaniatoZimbabweInmanycountries,activitiesinmanydifferentplacesParticipatingorganizationsincluded:societies,foundations,universities,colleges,hospitalsassociations,trustsandindividualsLocalactivitiesfocusedonraisingawarenessacrossallkeyaudiences:Public-at-large,GovernmentministersandHealthOfficials,PhysiciansandAlliedHealthProfessionals.WKD Successes(2)ParticipatingWorld Kidney Day Los Angeles 2010(2)Many Southern California Organizations joined together for this event(continued)March,20104.Kidney Disease Lectures at Scheduled Hospital Conferences,Universities-Academic Nephrologists.World Kidney Day Los Angeles 2World Kidney Day Los Angeles 2010(1)Many Southern California Organizations joined together for this event March 7,2010 1.Polycystic Kidney Disease/KidneyWise WalkMarch 11,2010 2.MinoritycommunityeducationprogramandfocusgroupsDrewPostgraduateMedicalSchool,CommunityOrganizations3.KEEP Dectetion Program National Kidney Foundation.World Kidney Day Los Angeles 2World Kidney Day Los Angeles 2010(3)Many Southern California Organizations joined together for this event(continued)March 13,20095.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 2World 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 .World Kidney Day Los Angeles 2March11,2010WorldKidneyDay.March 11,2010WorldKidneyDay.InterconnectionsBetweenObesity,DiabetesMellitus(DM),HighBloodPressure,andChronicKidneyDisease(CKD)RelationshipsbetweenObesity,Diabetes&CKD:i.ObesitypredisposestobothDiabetes&CKDii.Diabetesisthemostcommoncauseofend-stageCKDthatrequireschronicdialysistreatmentsorrenaltransplantationiii.Roughlyone-thirdofpeoplewithDiabeteswilldevelopCKD.Interconnections Between ObesiInterconnectionsBetweenObesity,DiabetesMellitus,HighBloodPressure,andChronicKidneyDisease(CKD)RelationshipsbetweenObesity,Diabetes&CKD:(continued)iv.Diabetesiseasytodetect,canbepreventedinmostcases,andcanusuallybetreatedeffectivelyinmostcases.Interconnections Between ObesiInterconnectionsBetweenObesity,DiabetesMellitus,HighBloodPressureandChronicKidneyDisease(CKD)RelationshipsbetweenObesity,Diabetes&CKD:v.TightglucosecontrolinDMappearstoreducetheriskforCKD.vi.BloodpressurecontrolreducestheharmfulcomplicationsofDM.vii.DMiseasytodetect,andinmostcases,itcanbepreventedandusuallytreatedeffectively.Interconnections Between ObesiInterconnectionsBetweenObesity,DiabetesMellitus,HighBloodPressure,andChronicKidneyDisease(CKD)RelationshipsbetweenCKD&highbloodpressure:i.Highbloodpressure,likechronickidneydisease(CKD),isoftensilentanddangerous.ii.HighbloodpressurecausesCKD.iii.CKDcausesHighbloodpressure.iv.BothCKDandHoghbloodpressurearecommonandtreatable.Interconnections Between ObesiInterconnectionsBetweenObesity,DiabetesMellitus,HighBloodPressure,andChronicKidneyDisease(CKD)RelationshipsbetweenObesity,Diabetes,CKD,HighbloodpressureversusVascularDisease:1.EachoftheabovefourconditionsincreasetheriskforCardiovascularandCerebrovascularDisease.2.Thisriskisoftenmarkedlyincreased.3.Togetherthese4diseases(Obesity,Diabetes,CKDandhighbloodpressure)causealargepercentageoftheillnessesanddeathsintheDevelopedandtheDevelopingWorld.Interconnections Between ObesiInterconnectionsBetweenObesity,DiabetesMellitus,HighBloodPressure,andChronicKidneyDisease(CKD)WhatcanWedotoPreventandTreattheseRelatedDiseasesandTheirHarmfulEffects?.Interconnections Between ObesiDiabetes:TightGlucose&BloodPressureControlandCVOutcomesStrokeAny DiabeticEndpointDMDeathsMicrovascularComplications-50-40-30-20-100%Reduction In Relative RiskTight 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 controlBakris GL,et al.Am J Kidney Dis.2000;36(3):646-661.Diabetes:Tight Glucose&BlooSuggestedGoalsforCKDPatientsesp.withDiabetesandHighBloodPressureLifestylemodifications(noobesity,regularexercise)BP130/80mmHgorlower,espindiabetesorproteinuria)Maximalreductionofproteinuria(1g/d)MultipleBPloweringmeds(3-4medsormore,ifneeded)ACEIs,ARBs,Diuretics,Beta-Blockers,Non-Dihydropyridine-CCBsHbA1cat7%(indiabetics)Dietaryproteinrestriction(0.6-0.8kg/d)Dietarysodiumrestriction(2-3g/dsodium)Lipid-loweringtherapy(diet,statins).Suggested Goals for CKD PatienWhatCanBeDone(3)?3.NewDirection:Wearebeginningtojoinwithotherdiseasefocusedgroupsandworldhealthdaysthatrelatetokidneydisease(forexample,WorldHypertensionDay,possiblyinthefuture,WorldDiabetesDay).What Can Be Done(3)?3.New DWorldKidneyDay-PlansFor2009(2)2.CollaborationwithWorldHypertensionDay.i.Sharemessagesonwebsites,inprintedmessages?ii.Placelinksonrespectivewebsites?iii.Inauguratecombinedprogramsinselectedcircumstances(2009WKDwilladdaHTNfocus).3.BasicPrincipal:Amessagehasthegreatestimpactwhenitisrepeatedmanytimesandindifferentwaysorbydifferentgroups.World Kidney Day-Plans For 200WorldKidneyDay-PlansFor2009(3)i.ItfollowsthatwemightallcomeclosertoachievingourrespectivegoalsifHeart,DiabetesandStrokejoininthislinkageeffortwithWHDandWKD.4.RolefortheVascularAlliance?i.Coordinatesuchlinkageefforts?ii.FacilitatetheliaisonbetweenVascularAllianceandtargetaudiences(eg,Nurses,familypractitioners,generalinternists,pharmacists,governmentministries,etc.).World Kidney Day-Plans For 200WorldKidneyDayFuturePlans1.IncreasePublicHealthMessage2.BringallKidneyDiseaseOrganizationstogetherforaUnifiedEffortandMessage(kidneyfoundations,societiesofnephrology,patientorganizations,communityactivists,medicalschools,teachinghospitals,insurers)3.EachcommunitytouseWKDastimetoannouncegoalsandtimelinesfortargetedimprovementsinpreventionandhealthcareforpeoplewithoratriskforkidneydisease.WKDisalsousedtoannouncethestatusandsuccessesoftheseefforts.World Kidney Day Future PlanPotential Evolution in Goals for World Kidney Day The goal is to use World Kidney Day as a mechanism to stimulate people to work together to improve the health care system as it affects public health,preventative medicine and acute and chronic medical care in their locality with regard to acute and chronic kidney disease.We want to have volunteers from kidney foundations,kidney patient organizations,societies of nephrology,other interested organizations and the public-at-large join together to attain these goals in their locality.Potential Evolution in Goals f