Influence of guideline adherence and parameter control on the clinical outcomes in patients with diabetic nephropathy

Abstract

IntroductionWe assessed the association between guideline adherence and outcomes of clinical parameter control and end-stage kidney disease (ESKD), and further studied the effect of parameter control on ESKD for Chinese patients with diabetic nephropathy (DN).Research design and methodsIn this retrospective study, 1128 patients with DN (15,374 patient-visit samples) diagnosed by renal biopsy were enrolled. Samples were classified as adherence and nonadherence based on whether prescribed drugs conformed to medication regimen and drug contraindication recommended by guidelines, including American Diabetes Association (ADA) and Chinese guidelines. Guideline adherence rate was calculated on all samples for antihyperglycemic, antihypertensive and lipid-lowering treatments. Clinical parameter control was compared after 3–6 months’ therapy between two groups by generalized estimating equation models. Time-dependent Cox models were applied to evaluate the influence of guideline adherence on ESKD. Latent class mixed model was used to identify distinct trajectories for parameters and their ESKD risks were compared using Cox proportional-hazards models.ResultsGuideline adherence rate of antihyperglycemic therapy was the highest, with 72.87% and 68.15% of samples meeting ADA and Chinese guidelines, respectively. Adherence was more likely to have good glycated hemoglobin A1c (HbA1c) control (ADA: OR 1.46, 95% CI 1.12 to 1.88; Chinese guideline: OR 1.42, 95% CI 1.09 to 1.85) and good blood pressure control (ADA: OR 1.35, 95% CI 1.03 to 1.78; Chinese guideline: OR 1.39, 95% CI 1.08 to 1.79) compared with nonadherence. The improvement of patient’s adherence showed the potential to reduce ESKD risk. For proteinuria, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure and uric acid, patients in higher-value trajectory group had higher ESKD risk. Proteinuria and LDL-C trajectories were most closely related to ESKD risk, while the risk was not significantly different in HbA1c trajectories.ConclusionsGuideline adherence and good control of proteinuria and LDL-C in clinical practice are important and in need for improving clinical outcomes in patients with DN.

A prediction model for end‐stage renal disease risk in Chinese diabetic patients

“…9 LDL-C, whose abnormality reflects dyslipidemia, was increased by hypoproteinemia during DN and was persistently increased if progressing to ESRD. 10 Proteinuria and LDL-C were most closely correlated with ESRD in Chinese DN patients. 10 China has an enormous cohort of T2DM patients, and Asian has a lower incidence of DN than five other ethnicities.…”

“…10 Proteinuria and LDL-C were most closely correlated with ESRD in Chinese DN patients. 10 China has an enormous cohort of T2DM patients, and Asian has a lower incidence of DN than five other ethnicities. 3 Gao's prediction model was generated from a large cohort of Chinese T2DM patients and could comprehensively evaluate essential pathologies to predict the progression of DN in Chinese T2DM patients.…”

“…LDL‐C, whose abnormality reflects dyslipidemia, was increased by hypoproteinemia during DN and was persistently increased if progressing to ESRD 10 . Proteinuria and LDL‐C were most closely correlated with ESRD in Chinese DN patients 10 …”

“…Anti‐hypertensive agents, including renin‐angiotensin system blockers, thiazides, calcium channel blockers and β blockers, decreased the risk of renal endpoint in diabetic patients 9 . LDL‐C, whose abnormality reflects dyslipidemia, was increased by hypoproteinemia during DN and was persistently increased if progressing to ESRD 10 . Proteinuria and LDL‐C were most closely correlated with ESRD in Chinese DN patients 10 …”

Doctors' adherence to guidelines recommendations and glycaemic control in diabetic patients in Quetta, Pakistan: Findings from an observational study

“…These guidelines contain recommendations based on high quality evidence obtained from large and rigorously conducted randomized control trials, individual patients' data meta-analyses, systematic reviews and expert opinions ( 9 , 10 ). Compliance with these guidelines have resulted in optimal glycemic control and preventing micro and macrovascular complications of DM ( 11 – 18 ). Nevertheless, a wide gap is present between guidelines recommendations and actual clinical practices ( 19 – 36 ).…”