Diabetes and renal disease: who does what?

Abstract

-Care of patients with diabetes and chronic kidney disease (CKD) in the UK is divided between primary care, diabetologists and nephrology. In a retrospective analysis, we examined the distribution of care provision for patients with diabetes and CKD. Nephrology services see a minority of diabetic patients with CKD, but they see the majority of those with an estimated glomerular filtration rate (eGFR) of <30 ml/min. Of those followed in nephrology, 70% showed no evidence of progressive renal dysfunction. The nephrology cohort were significantly younger that those seen by primary care physicians or diabetologists. Half of the patients with diabetes and CKD seen in either the primary care and diabetology cohorts, with no nephrology input, had a rate of fall of eGFR of >5 ml/min/yr. This suggests that older age might deter referral to nephrology, which is based predominantly on CKD stage. This results in a significant proportion of patients with stable renal function being seen by nephrology, and in the under-referral of a large cohort of patients with progressive CKD.

The directional and non‐directional associations of periodontitis with chronic kidney disease: A systematic review and meta‐analysis of observational studies

“…Control of common risk factors for CKD and periodontitis was conducted on the study design or the statistical analysis in several studies to ensure a valid comparability (Appendix A,B). Besides the demographic and socio‐economic characteristics, considerations on the major confounders such as tobacco smoking and diabetic status were made by 10 studies, indicating a statistically significant link between CKD and periodontitis (Appendix A,B). Furthermore, the information provided for the frequency of dental visits was limited .…”

Inhibition of 12/15-Lipoxygenase Reduces Renal Inflammation and Injury in Streptozotocin-Induced Diabetic Mice

“…The progression of DN manifests itself symptomatically via impairment in the glomerular filtration barrier resulting in microalbuminuria. Consequently, this evolves into more devastating complications including hypertension, progressive injury of the glomerular structure and thickening of the glomerular basement membrane, increased collagen deposition and macroalbuminuria [2-4]. Proper control of blood glucose levels reduces the risk of DN; however, new therapeutic strategies are required to prevent the incidence of early diabetic renal injury and counteract the expected progression to end-stage renal disease and dialysis among the rapidly expanding diabetic population.…”

A programme to spread eGFR graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease (ASSIST-CKD): protocol for the stepped wedge implementation and evaluation of an intervention to reduce late presentation for renal replacement therapy

“…However cross-sectional data indicate that people with earlier but progressive disease are frequently not recognised and referred by primary care, and that many patients with more advanced but stable disease continue to attend hospital clinics where ongoing specialist input may result in little added value [16]. …”