Long-term outcomes of patients with type 2 diabetes attending a multidisciplinary diabetes kidney disease clinic
在多学科糖尿病肾病诊所就诊的2型糖尿病患者的长期预后
Abstract
enBackground
The best model of care to retard diabetic kidney disease (DKD) in the clinic is underexplored. In this study we investigated the long-term renal outcomes of a joint endocrinologist–nephrologist clinic.
Methods
The present study was a nested case-control study derived from a cohort of patients with type 2 diabetes mellitus (T2DM) seen prospectively at a secondary care diabetes center (DC). Cases (“DKD clinic group”) were patients seen at the CKD clinic after being referred by physicians in DCs for management of DKD. Controls (“non-DKD clinic group”) were patients from the same DC (i.e. same source population) with the same inclusion criteria of Stages 3–4 chronic kidney disease (CKD) at baseline but not seen at the DKD clinic. The outcome was Stage 5 CKD, defined as an estimated glomerular filtration rate <15 mL/min per 1.73 m2.
Results
During the median follow-up period of 3.0 years (interquartile range 1.2–5.1 years), 240 patients (28.7%) reached Stage 5 CKD, with 45.8% and 54.2% of those reaching Stage 5 CKD in the DKD and non-DKD clinic groups, respectively. Multivariable Cox regression revealed that the DKD clinic group had a lower risk of progressing to Stage 5 CKD (hazard ratio 0.55; 95% confidence interval 0.36–0.83; P = 0.004) compared with the non-DKD clinic group.
Conclusions
Multidisciplinary endocrinology and nephrology care in the DKD clinic is associated with a lower risk of end-stage renal disease. These findings may inform future management strategies targeted at patients with T2DM and CKD, especially with regard to joint specialist management involving endocrinologists and nephrologists.
摘要
zh背景
可以延缓糖尿病肾病(diabetic kidney disease, DKD)进展的最佳诊所护理模式目前尚在探索之中。本研究中我们调查了在一个由内分泌学家-肾病学家联合坐诊的诊所中患者的长期肾脏预后情况。
方法
这项研究是一个巢式病例对照研究, 对来自于二级糖尿病护理中心(diabetes center, DC)的2型糖尿病(T2DM)患者进行了前瞻性的队列研究。病例组(“DKD诊所组”)为经DC的医生转诊后在CKD诊所就诊并且接受DKD管理的患者。对照组(“非DKD诊所组”)为来自于同一个DC(亦即同源人群)且不在DKD诊所就诊的3-4期慢性肾脏疾病(chronic kidney disease, CKD)患者, 基线时他们的入选标准也一样。终点为CKD5期, 定义为估算的肾小球滤过率< 15 mL/min/1.73m2。
结果
在中位数为3.0年(四分位数范围为1.2-5.1年)的随访期间, 有240名患者(28.7%)达到了CKD5期, DKD诊所就诊组与非DKD诊所就诊组中分别有45.8%与54.2%的患者达到了CKD5期。多变量Cox回归分析结果显示, DKD诊所就诊组与非DKD诊所就诊组相比患者进展为CKD5期的风险较低(危险比为0.55;95%置信区间为0.36-0.83;P = 0.004)。
结论
在DKD诊所经内分泌与肾脏病多学科联合治疗与患者进展为终末期肾病的风险更低有关。这些研究结果表明, 将来针对T2DM合并CKD患者的管理策略可能需要调整, 特别是涉及到的内分泌学家与肾病学家的联合专科管理。
