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Long‐term effectiveness of a community‐based model of care in M āori and P acific patients with type 2 diabetes and chronic kidney disease: a 4‐year follow up of the DE lay F uture E nd S tage N ephropathy due to D iabetes ( DEFEND ) study
Author(s) -
Tan J.,
Manley P.,
Gamble G.,
Collins J.,
Bagg W.,
Hotu C.,
Braatvedt G.
Publication year - 2015
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12788
Subject(s) - medicine , interquartile range , kidney disease , renal function , dialysis , diabetic nephropathy , diabetes mellitus , type 2 diabetes , proteinuria , end stage renal disease , nephropathy , retrospective cohort study , blood pressure , hemodialysis , kidney , endocrinology
Background/Aim The D elay F uture E nd S tage N ephropathy due to D iabetes study was a randomised controlled trial of M āori and Pacific patients with advanced diabetic nephropathy, comparing a community‐based model of care with usual care. The intervention group achieved lower blood pressure ( BP ), proteinuria and less end‐organ damage. After the intervention ended, all patients reverted to usual care, and were followed to review the sustainability of the intervention. Methods A retrospective observation of 65 patients (aged 47–75 years) with type 2 diabetes, hypertension, chronic kidney disease 3/4 and proteinuria (>0.5 g/day) previously randomised to intervention/community care or usual care for 11–21 months. Follow up thereafter was until death, end‐stage renal disease ( ESRD ) (estimated glomerular filtration rate (e GFR ) ≤ 10 mL/min/1.73 m 2 )/dialysis or 1 F ebruary 2014. Primary end‐points were death and ESRD /dialysis. Secondary outcomes were annualised glomerular filtration rate decline, non‐fatal vascular events and hospitalisations. Results Median (interquartile ranges ( IQR )) post‐trial follow up was 49 (21–81) months and similar in both groups. The median ( IQR ) eGFR decline was −3.1 (−5.5, −2.3) and −5.5 (−7.1, −3.0) mL/min/year in the intervention and usual care groups respectively ( P = 0.11). Similar number of deaths, renal and vascular events were observed in both groups. At the end of follow up, the number of prescribed antihypertensive medications was similar (3.4 ± 1.0 vs 3.3 ± 1.4; P = 0.78). There were fewer median ( IQR ) hospital days (8 (3, 18) vs 15.5 (6, 49) days, P = 0.03) in the intervention group. Conclusions Short‐term intensive BP control followed by usual care did not translate into reduction in long‐term mortality or ESRD rates, but was associated with reduced hospitalisations.