BÖLÜM


DOI :10.26650/B/CH12CH47.2023.014.13   IUP :10.26650/B/CH12CH47.2023.014.13    Tam Metin (PDF)

Geri̇atri̇k Di̇yabeti̇k Hastalarda Böbrek Tutulumu Ve Tedavi̇si̇

Onur TuncaM. Sena Ulu

İçinde bulunduğumuz evren ve üzerinde nefes aldığımız dünya giderek yaşlanırken, bu yaşlanma ortalama insan ömrüne de yansımış gibi gözükmektedir. 20.yy. ortalarından günümüze dek ortalama yaşam süresinin oldukça arttığı bilinmektedir. 21.yy. ortalarında ise bu sürenin 30 yıla kadar uzaması öngörülmektedir. Çeyrek yüzyıl sonra 60 yaş üzeri nüfusun toplam dünya nüfusunun 5’te 1’inden fazla olacağı tahmin edilmektedir1,2. Diğer bir deyişle 2050 yılında 60 yaş üzeri nüfusun 2 milyarın üzerinde olacağı ön görülmektedir1 . Yaşlı nüfusta onkolojik problemler, kardiyovasküler hastalıklar ve de geriatrik sendromlar oldukça sık görülür3 . Özellikle düşmeye bağlı kırıklar, işitme-görme problemleri, depresyon, bilişsel fonksiyonlarda gerileme, kas kayıpları, çoklu ilaç kullanımı ve idrar inkontinansı ön sıralarda yer almaktadır4,5. Ek olarak sadece yaşlanmanın kendisinin bozulmuş glukoz toleransı ile ilişkili olduğunu bildiren görüşler mevcuttur6 . Giderek uzayan bu ömürde özellikle 75 yaş üzeri insanlarda diyabetes Mellitus (DM) prevalansının ve hatta can sıkıcı komplikasyonlarından birisi olan böbrek tutulumunun arttığı aşikardır. Diyabetik böbrek hastalığı ya da diyabetik nefropati (DN) olarak adlandırılan bu durum ne yazık ki son zamanlarda yaşlı bireylerde gözlenen olmazsa olmaz hastalıklar arasında yer almaktadır. Geriatrik hastalarda DN açısından koruyucu önlemler oldukça dar bir alana hapsolmuş durumdadır. Progresyonun yavaşlatılması adına glisemik kontrol, kan basıncı (KB) kontrolü, lipid düşürücü tedavi ve diyet yaklaşımları nispeten daha genç kuşak diyabet hastalarından elde edilen deneyimler ile sınırlıdır. Sadece 60 yaş üzerinde diyabet hastası olmak, iyi bir kardiyovasküler koruma sağlanmış olsa bile tek başına diyabet komplikasyonları açısından bağımsız bir risk faktörü olarak değerlendirilmektedir. Bu nedenle yaşlı diyabetik hastalarda daha bütüncül bir bakış açısıyla tedavi hedeflerinin gözden geçirilmesi gerekmektedir.7



Referanslar

  • 1. Nadolnik K, Skrypnik D, Skrypnik K, Bogdanski P. diyabetic nephropathy in the elderly - clinical practice. Rocz Panstw Zakl Hig 2018;69(4):327-34. google scholar
  • 2. Unies N. Political declaration and Madrid international plan of action on ageing. UN; 2003. google scholar
  • 3. Organization WH. World report on ageing and health. World Health Organization; 2015. google scholar
  • 4. Laiteerapong N, Karter AJ, Liu JY, et al. Correlates of quality of life in older adults with diyabetes: the diyabetes & aging study. diyabetes Care 2011;34(8):1749-53. google scholar
  • 5. Kalyani RR, Corriere M, Ferrucci L. Age-related and disease-related muscle loss: the effect of diyabetes, obesity, and other diseases. lancet diyabetes Endocrinol 2014;2(10):819-29. google scholar
  • 6. Chang AM. Halter JB. Aging Insul secretion Am J Physiol Endocrinol Metab 2003;284:E7-12. google scholar
  • 7. Abdelhafiz AH, Nahas M El, de Oliveira JMF. Management of diyabetic nephropathy in older patients: A need for flexible guidelines. Postgrad Med 2014;126(4):171-7. google scholar
  • 8. Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF diyabetes Atlas: Global estimates for the preva-lence of diyabetes for 2015 and 2040. diyabetes Res Clin Pract 2017;128:40-50. google scholar
  • 9. Ho QY, Chung SJ, Low SCS, et al. Evaluating potential deceased donor renal transplant recipients for asymptomatic COVID-19. Transplant Direct 2020;6(6). google scholar
  • 10. Employment ECD-G for, Opportunities E. The Social Situation in the European Union 2005-2006: Over-view. 2007; google scholar
  • 11. Narayan KMV, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ. Impact of recent increase in incidence on future diyabetes burden: US, 2005-2050. diyabetes Care 2006;29(9):2114-6. google scholar
  • 12. Hill CJ, Fogarty D. Changing trends in end-stage renal disease due to diyabetes in the United Kingdom. J Ren Care 2012;38:12-22. google scholar
  • 13. Koye DN, Magliano DJ, Nelson RG, Pavkov ME. The global epidemiology of diyabetes and kidney disease. Adv Chronic Kidney Dis 2018;25(2):121-32. google scholar
  • 14. Joseph AJ, Friedman EA. diyabetic Nephropathy in the Elderly. Clin Geriatr Med 2009;25(3):373-89. google scholar
  • 15. Blickle JF, Doucet J, Krummel T, Hannedouche T. diyabetic nephropathy in the elderly. diyabetes Metab 2007;33:S40-55. google scholar
  • 16. Çeliker M, Selçuk MY, Olt S. Sarcopenia in diyabetic nephropathy: a cross-sectional study. Rom J Intern Med 2018;56(2):102-8. google scholar
  • 17. Süleymanlar G, Uta C, Arinsoy T, et al. A population-based survey of Chronic REnal Disease in Turkey-the CREDIT study. Nephrol Dial Transplant 2011;26(6):1862-71. google scholar
  • 18. Güngör Ö, Ulu S, Arıkan H, Kutlay S, Arıcı M, Altun B, Ateş B. Diyabetik Böbrek Hastalarında Hipergli-seminin İlaçlarla Yönetimi-TND Uzman Görüşü Raporu 2020 google scholar
  • 19. Williams ME. diyabetic Kidney Disease in Elderly Individuals. Med Clin North Am [Internet] 2013;97(1):75-89. Available from: http://dx.doi.org/10.1016/j.mcna.2012.10.011 google scholar
  • 20. Plante GE. Impact of aging on the body’s vascular system. Metabolism 2003;52:31-5. google scholar
  • 21. Cullen-McEwen LA, Kett MM, Dowling J, Anderson WP, Bertram JF. Nephron number, renal function, and arterial pressure in aged GDNF heterozygous mice. Hypertension 2003;41(2):335-40. google scholar
  • 22. Thomson SC, Vallon V, Blantz RC. Kidney function in early diyabetes: the tubular hypothesis of glomerular filtration. Am J Physiol Physiol 2004; google scholar
  • 23. Verzola D, Gandolfo MT, Gaetani G, et al. Accelerated senescence in the kidneys of patients with type 2 diyabetic nephropathy. Am J Physiol Physiol 2008;295(5):F1563-73. google scholar
  • 24. Semba RD, Nicklett EJ, Ferrucci L. Does accumulation of advanced glycation end products contribute to the aging phenotype? Journals Gerontol Ser A Biomed Sci Med Sci 2010;65(9):963-75. google scholar
  • 25. Mei C, Zheng F. Chronic inflammation potentiates kidney aging. In: Seminars in nephrology. Elsevier; 2009. p. 555-68. google scholar
  • 26. Cordonnıer DJ, Pınel N, Barro C, et al. Expansion of cortical interstitium is limited by converting enzyme inhibition in type 2 diyabetic patients with glomerulosclerosis. J Am Soc Nephrol 1999;10(6):1253-63. google scholar
  • 27. Premaratne E, Macisaac RJ, Tsalamandris C, Panagiotopoulos S, Smith T, Jerums G. Renal hyperfiltration in type 2 diyabetes: effect of age-related decline in glomerular filtration rate. diyabetologia 2005;48(12):2486-93. google scholar
  • 28. Barzilay JI, Peterson D, Cushman M, et al. The relationship of cardiovascular risk factors to microalbumi-nuria in older adults with or without diyabetes mellitus or hypertension: the cardiovascular health study. Am J Kidney Dis 2004;44(1):25-34. google scholar
  • 29. O’Hare AM, Hailpern SM, Pavkov ME, et al. Prognostic implications of the urinary albumin to creatinine ratio in veterans of different ages with diyabetes. Arch Intern Med 2010;170(11):930-6. google scholar
  • 30. Barzilay JI, Fitzpatrick AL, Luchsinger J, et al. Albuminuria and dementia in the elderly: a community study. Am J kidney Dis 2008;52(2):216-26. google scholar
  • 31. Wasen E, Isoaho R, Mattila K, Vahlberg T, Kivela S-L, Irjala K. Renal impairment associated with diyabetes in the elderly. diyabetes Care 2004;27(11):2648-53. google scholar
  • 32. Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J kidney Dis 2002;40(2):221-6. google scholar
  • 33. Roos JF, Doust J, Tett SE, Kirkpatrick CMJ. Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children—a meta-analysis. Clin Biochem 2007;40(5-6):383-91. google scholar
  • 34. Renko M, Tapanainen P, Tossavainen P, Pokka T, Uhari M. Meta-analysis of the significance of asympto-matic bacteriuria in diyabetes. diyabetes Care 2011;34(1):230-5. google scholar
  • 35. KOH K, Dayanath B, Doery JC, Polkinghorne KR, Teede H, Kerr PG. Effect of exercise on albuminuria in people with diyabetes. Nephrology 2011;16(8):704-9. google scholar
  • 36. Robles NR, Felix FJ, Fernandez-Berges D, et al. Prevalence of abnormal urinary albumin excretion in elderly people: a Spanish survey. Int Urol Nephrol 2013;45(2):553-60. google scholar
  • 37. California Healthcare Foundation/American Geriatrics Society Panel in Improving Care for Elders with diyabetes C. Guidelines for improving the care of the older person with diyabetes mellitus. J Am Geriatr Soc 2003;51(5s):265-80. google scholar
  • 38. Burrows NR, Li Y, Geiss LS. Incidence of treatment for end-stage renal disease among individuals with diyabetes in the US continues to decline. diyabetes Care 2010;33(1):73-7. google scholar
  • 39. Group A to CCR in DS. Effects of intensive glucose lowering in type 2 diyabetes. N Engl J Med 2008;358(24):2545-59. google scholar
  • 40. Group AC. Intensive blood glucose control and vascular outcomes in patients with type 2 diyabetes. N Engl J Med 2008;358(24):2560-72. google scholar
  • 41. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diyabetes. N Engl J Med 2009;360(2):129-39. google scholar
  • 42. Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO. The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diyabetes: a decision analysis. Ann Intern Med 2008;149(1):11-9. google scholar
  • 43. Abbatecola AM, Paolisso G, Corsonello A, Bustacchini S, Lattanzio F. Antidiyabetic oral treatment in older people. Drugs Aging 2009;26(1):53-62. google scholar
  • 44. Association AD. 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in diya-betes—2021. diyabetes Care 2021;44(Supplement_1):S111-24. google scholar
  • 45. Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diyabetes, pre-diyabetes, and cardiovas-cular diseases developed in collaboration with the EASD. Eur Heart J 2020;41(2). google scholar
  • 46. Sarafidis P, Ferro CJ, Morales E, et al. SGLT-2 inhibitors and GLP-1 receptor agonists for nephroprotection and cardioprotection in patients with diyabetes mellitus and chronic kidney disease. A consensus statement by the EURECA-m and the DIABESITY working groups of the ERA-EDTA. Nephrol Dial Transplant 2019;34(2):208-30. google scholar
  • 47. de Boer IH, Caramori ML, Chan JCN, et al. Executive summary of the 2020 KDIGO diyabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment. Kidney Int 2020;98(4):839-48. google scholar
  • 48. Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis 2014;63(5):713-35. google scholar
  • 49. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diyabetes, 2015: a patient-centred approach. Update to a position statement of the American diyabetes Association and the European Association for the Study of diyabetes. diyabetologia 2015;58(3):429-42. google scholar
  • 50. Becker GJ, Wheeler DC, De Zeeuw D, et al. Kidney disease: Improving global outcomes (KDIGO) blood pressure work group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl 2012;2(5):337-414. google scholar
  • 51. Suissa S, Hutchinson T, Brophy JM, Kezouh A. ACE-inhibitor use and the long-term risk of renal failure in diyabetes. Kidney Int 2006;69(5):913-9. google scholar
  • 52. Parving H-H, Brenner BM, McMurray JJ V, et al. Cardiorenal end points in a trial of aliskiren for type 2 diyabetes. N Engl J Med 2012;367(23):2204-13. google scholar
  • 53. Young JH, Klag MJ, Muntner P, Whyte JL, Pahor M, Coresh J. Blood pressure and decline in kidney function: findings from the Systolic Hypertension in the Elderly Program (SHEP). J Am Soc Nephrol 2002;13(11):2776-82. google scholar
  • 54. Levey AS, Rocco M V, Anderson S, et al. K/DOQI clinical practice guidelines on hypertension and antihy-pertensive agents in chronic kidney disease. Am J Kidney Dis 2004;43(5 SUPPL. 1):i-S290. google scholar
  • 55. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358(18):1887-98. google scholar
  • 56. van Hateren KJJ, Landman GWD, Kleefstra N, et al. Lower blood pressure associated with higher mortality in elderly diyabetic patients (ZODIAC-12). Age Ageing 2010;39(5):603-9. google scholar
  • 57. Cooper-DeHoff RM, Gong Y, Handberg EM, et al. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diyabetes and coronary artery disease. Jama 2010;304(1):61-8. google scholar
  • 58. Brenner BM, Cooper ME, De Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diyabetes and nephropathy. N Engl J Med 2001;345(12):861-9. google scholar
  • 59. Basi S, Lewis JB. Microalbuminuria as a target to improve cardiovascular and renal outcomes. Am J Kidney Dis 2006;47(6):927-46. google scholar
  • 60. Baigent C. Cholesterol Treatment Trialists’(CTT) Collaborators: Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-78. google scholar
  • 61. Petersen LK, Christensen K, Kragstrup J. Lipid-lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80+-year olds. Age Ageing 2010;39(6):674-80. google scholar
  • 62. Mielke MM, Zandi PP, Sjögren M, et al. High total cholesterol levels in late life associated with a reduced risk of dementia. Neurology 2005;64(10):1689-95. google scholar
  • 63. Suckling RJ, He FJ, MacGregor GA. Altered dietary salt intake for preventing and treating diyabetic kidney disease. Cochrane Database Syst Rev 2010;(12). google scholar
  • 64. Baggio B, Budakovic A, Dalla Vestra M, Saller A, Bruseghin M, Fioretto P. Effects of cigarette smoking on glomerular structure and function in type 2 diyabetic patients. J Am Soc Nephrol 2002;13(11):2730-6. google scholar


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İstanbul Üniversitesi Yayınları, uluslararası yayıncılık standartları ve etiğine uygun olarak, yüksek kalitede bilimsel dergi ve kitapların yayınlanmasıyla giderek artan bilimsel bilginin yayılmasına katkıda bulunmayı amaçlamaktadır. İstanbul Üniversitesi Yayınları açık erişimli, ticari olmayan, bilimsel yayıncılığı takip etmektedir.