Objective To evaluate the influence of chronic kidney disease (CKD) outpatient management on the disease progression and dialysis initiation in diabetic kidney disease (DKD) patients, so as to provide a basis for continuous improvement of the multidisciplinary management of CKD outpatients and DKD patients. Methods This study enrolled 92 DKD patients with initial hemodialysis from the CKD Outpatient Clinic (management group, group M) and 94 DKD patients with initial hemodialysis from the Nephrology Clinic (non-management group, group NM) in the Affiliated Hospital of Jiangsu University in the period from June 2015 to June 2021. Biochemical indexes, vascular access, hospitalization and renal function changes were compared between the two groups at the first dialysis. The impact of various factors on disease progression was evaluated by Cox regression analysis. Results At dialysis entry, systolic blood pressure, estimated glomerular filtration rate (eGFR), and serum whole parathyroid hormone were significantly lower in group M than in group NM (t=-3.352, -1.196 and -1.995 respectively; P=0.001, 0.047 and 0.047 respectively), and hemoglobin, serum creatinine and albumin were significantly higher in group M than in group NM (t=2.320, 2.189 and 2.102 respectively; P=0.021, 0.030 and 0.037 respectively); vascular access, emergent dialysis and the ratio of first induced dialysis at the first dialysis were significantly different between the two groups (c2=19.573, 16.396 and 16.969 respectively; P＜0.001). Kaplan-Meier survival analysis showed that the median disease course entering dialysis was significantly longer in group M than in group NM (t=2.239, P=0.21). Multivariate regression analysis showed that age, diabetic retinopathy, urinary microalbumin/creatinine were the risk factor for DKD progression (HR=1.020, 0.554 and 1.000 respectively, 95% CI: 1.003~1.038, 0.405~0.757 and 1.000~1.000 respectively; P=0.019, ＜0.001 and ＜0.001 respectively). CKD management and treatment with angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blocker (ARB) could postpone the DKD progression. Conclusion CKD management can significantly delay the progression of DKD. In outpatient management, early screening of diabetic retinopathy, management of urinary protein, and early use of ACEI/ARB medications are helpful to delay the DKD progression.
YU Shu
,
JIA Jue
,
WANG Tao-Tao
,
XU Feng-Lan
,
HUA Qin
,
GUI Lan-Lan
,
HE Jian-Qiang
. Effect of chronic kidney disease management on the disease progression and dialysis initiation in diabetic kidney disease patients[J]. Chinese Journal of Blood Purification, 2023
, 22(06)
: 415
-420
.
DOI: 10.3969/j.issn.1671-4091.2023.06.004
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