résumés des cours et travaux - Collège de France

930 RÉSUMÉS DES COURS ET CONFÉRENCES
b) the National Kidney Foundation Kidney Early Evaluation Program (KEEP) ; and
c) the National Health and Nutrition Examination Survey (NHANES) 1999-2004.
All three cohorts also provide prevalence estimates for co-morbidities such as
cardiovascular and cerebrovascular disease.
The REGARDS and KEEP cohorts are older than the NHANES cohort, and
have slightly greater prevalence of more advanced CKD (Stage 3) than the
NHANES cohort. These cohorts are the undergoing longitudinal evaluation to
prospectively determine the incidence of cardiovascular disease (MI and CHF),
cerebrovascular disease (strokes and TIAs), and progressive CKD and ESRD. Based
on self-reported history of co-morbidities, there appears to be an association
between CKD (eGFR < 60 ml/min/1.73 m 2 ) and AMI and stroke, with an
increased risk, adjusted for traditional (e.g., Framingham) risk factors of 35%.
These prevalence estimates and associations will be converted to actual hazard
ratios and detailed definition of the importance of traditional (i.e., systolic
hypertension, diabetes, smoking, cholesterol, age, gender) and non-traditional
(CKD stage, anemia, inflammation, ethnicity) risk factors for the occurrence of
stroke, cardiovascular events and ESRD.
Proteinuria, Hypertension and Chronic Kidney Disease Progression
Effective blood pressure control, especially of the systolic component, is of
primary importance in both primary and secondary prevention of Cardiovascular
and Cerebrovascular Events. Similarly, systolic blood pressure control is important
in the primary and secondary prevention of chronic kidney disease (CKD), and in
patients for whom kidney function is already affected, the focus is on preventing the
worsening of their current condition, which is described as slowing the “progression”
of CKD. Progression of CKD is usually quantified as the linear slope with time
of changes in the glomerular filtration rate, expressed as ml/min/1.73 m 2 /year. In
addition to systolic blood pressure, control of hyperlipidemia, anemia management,
smoking cessation and dietary salt intake at the recommended daily allowance of
2.4 grams of sodium are part of the general approach to optimizing outcomes in
patients with CKD.
Proteinuria is an important biomarker is many forms of CKD, including type
I, and type II diabetes mellitus. Even in forms of CKD not usually associated with
proteinuria (e.g., autosomal dominant polycystic kidney disease), reduction of
urine protein excretion with “anti-proteinuric” therapy can have a beneficial effect
on the rate of progression CKD. Proteinuria is a biomarker of kidney damage, and
may also directly contribute to the ongoing damage to the kidney in CKD
associated with proteinuria. Angiotensin converting enzyme inhibitors (ACEIs),
and angiotensin type 1-receptor blockers (ARBs), used either alone or in
combination are the mainstays of antiproteinuric therapy. This effect is well
described, and seems greater than that seen with other classes of antihypertensive