Q J Med 2002; 95: 41-49
© 2002 Association of Physicians
Diabetic nephropathy: how effective is treatment in clinical practice?
From the Renal Unit and 1 Diabetic Unit, Glasgow Royal Infirmary, Glasgow, UK
Received 7 August 2001 and in revised form 26 October 2001
Background: Diabetic nephropathy is the most common cause of end-stage renal failure in patients starting dialysis in the developed world. In clinical trials, interventions, particularly blood pressure control, have achieved major reductions in the rate of decline in renal function.
Aim: To investigate whether results from clinical trials can be achieved in routine clinical practice.
Design: Observational study of 170 consecutive patients referred to a combined diabetic-renal clinic over a 10 year period.
Methods: We collected demographic and laboratory data from the electronic patient record.
Results: Median serum creatinine at referral was 170 µmol/l and was >350 µmol/l in 26% of patients. Mean blood pressure (BP) was 159/85. The publication of guidelines by the Scottish Intercollegiate Guidelines Network in 1997, recommending more active intervention and earlier referral, had no impact on referral BP and creatinine. In the 125 patients with at least 1 year follow-up, significant improvements in BP, albuminuria, HbA1c and serum cholesterol were seen. In the 63 patients followed up for 3 years (median creatinine 120 µmol/l), the median rate of decline in renal function slowed from 0.52 ml/min/month (first year) to 0.27 ml/min/month (third year) (p=0.003), nearly doubling the time to end-stage renal failure.
Discussion: Patients referred early to a combined diabetic-renal clinic benefited by slowing in the rate of decline of renal function. A challenging but achievable standard for audit would be to reduce the rate of progression to <0.25 ml/min/month in 70% of patients with diabetic nephropathy presenting with a serum creatinine <150 µmol/l.
Address correspondence to Dr N. Joss, Renal Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF. e-mail: njoss{at}compuserve.com
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. J. Kelly and G. Booth Pharmacist-led structured care for patients with diabetic nephropathy The British Journal of Diabetes & Vascular Disease, March 1, 2008; 8(2): 86 - 88. [Abstract] [PDF]
|
|