Boot M, Fielding K
Introduction
Chronic Kidney Disease (CKD) contributes a significant burden to morbidity and mortality worldwide. The leading contributor of CKD is diabetes mellitus (DM) also known as diabetic kidney disease (DKD). Early detection and management of DKD is imperative in slowing disease progression. Management according to Royal Australian College of General Practice (RACGP) includes strict blood glucose control, blood pressure control, utilisation of reno-protective medications with microalbuminuria and lifestyle changes.
Aim
This research aimed to investigate if GP’s were adherent to RACGP DKD management guidelines. The research objective was to evaluate whether the management had an impact on DKD progression, focusing on glycaemic control, smoking history, SGLT2i use, GP’s adherence to guidelines and eGFR progression.
Method/Description
This was a retrospective cohort analysis over a five-year period (2015 – 2019) of n=69 type 2 DM patients with DKD. This cohort was categorised according to age: Group A (< 70 years, n=33) & Group B (> 70 years, n=36). Sex, age, years since diagnosis, smoking status, years on reno-protective treatment, current T2DM treatment, HbA1c, and use of SGLT2i were recorded and compared to the rate of change of eGFR over 5 years. Analysis was performed using a chi square test.
Results
The major finding of this study was that there was poor adherence to RACGP guidelines by GP’s. Approximately 67% of patients in both group A and B were not prescribed reno-protective medication within the recommended time frame. These patients represented a higher percentage of progressive DKD. Group A had poorer glycaemic control and higher rates of smoking. Poor glycaemic control represented a larger percentage of participant with progressive DKD.Group B had better glycaemic control, more non-smokers and higher rates of DKD progression.
Consclusions
Practitioners should review their practice and adherence to reno-protective medication prescription guidelines in DKD management. This study illustrates the need for patient education focussed on improving glycaemic control and smoking cessation. There is the need for future studies reviewing the use of SGLT2i’s as a part of DKD management to help prevent disease progression.