Open AccessEstimated glomerular filtration rate progression in UK primary care patients with type 2 diabetes and diabetic kidney disease: a retrospective cohort study
Author(s) -
Cid Ruzafa J.,
Paczkowski R.,
Boye K. S.,
Di Tanna G. L.,
Sheetz M. J.,
Donaldson R.,
Breyer M. D.,
Neasham D.,
Voelker J. R.
Publication year - 2015
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.12640
Subject(s) - medicine , albuminuria , renal function , kidney disease , diabetes mellitus , type 2 diabetes , retrospective cohort study , cohort , population , type 2 diabetes mellitus , confidence interval , cohort study , endocrinology , environmental health
Summary Aims To examine the rates of diabetic kidney disease ( DKD ) progression and associated factors, we undertook a study of estimated glomerular filtration rate ( eGFR ) in a historical cohort of UK primary care patients with type 2 diabetes mellitus (T2 DM ) and associated DKD from the Clinical Practice Research Datalink. Methods Our eligible population were patients with definitive T2 DM from a recorded diagnostic code with either a diagnosis of chronic kidney disease ( CKD ) or renal function test values and renal abnormalities consistent with a CKD diagnosis, identified between 1 October 2006 and 31 December 2011. Only patients with albuminuria results reported in mg/l were used for the longitudinal statistical analyses of the eGFR rate of change using multilevel models. Results We identified 111,030 patients with T2 DM . Among them 58.6% (95% confidence interval ( CI ): 58.3–58.9) had CKD and 37.2% (95% CI : 36.9–37.5%) had presumed DKD at baseline. Only 19.4% of patients had urinary albumin test results expressed as mg/l in the year prior to index date. Almost two‐thirds (63.8%) of patients with T2 DM and presumed DKD received prescriptions for angiotensin‐converting enzyme ( ACE ) inhibitors or angiotensin type 1 receptor blockers ( ARB ) or both. Time‐dependent variables that predict subsequent eGFR decline include increased albuminuria, time from index date and older age. Conclusion Only a minority of diabetic patients with DKD had quantitative albuminuria assessments. The relatively low proportion of DKD patients with ACE i or ARB prescriptions suggests a gap between healthcare practice and available scientific evidence during the study period. Increased albuminuria and older age were the most consistent predictors of subsequent eGFR decline.