medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2008, Number 3

<< Back Next >>

Rev Invest Clin 2008; 60 (3)

How frequently the clinical practice recommendations for nephropathy are achieved in patients with type 2 diabetes mellitus in a primary health-care setting?

Martínez-Ramírez HR, Cortés-Sanabria L, Rojas-Campos E, Barragán G, Alfaro G, Hernández M, Canales-Muñoz JL, Cueto-Manzano AM

Language: English
References: 41
Page: 217--226
PDF size: 130.14 Kb.


ABSTRACT

Objective. To determine the proportion of DM2 patients in primary health-care setting who meet clinical practice recommendations for nephropathy. Material and methods. 735 patients were included in this cross-sectional study. Nephropathy was defined as glomerular filtration rate ‹ 60 mL/min/1.73 m2 or albuminuria ≥ 30 mg/day. To estimate the proportion of patients meeting clinical practice recommendations, the achieved level was classified according to NKF –K/DOQI, ADA, IDF, JNC 7 report, and NCEPATPIII. Results. A high frequency of kidney disease and cardiovascular risk factors (smoking, alcoholism, obesity) was observed. Adequate levels were attained in 13% for fasting glucose, 45% for blood pressure, 71% for albuminuria, and 30% for lipids. Nephropathy was diagnosed in 41%. Adequate systolic blood pressure was observed in 40% of patients with nephropathy vs. 49% without nephropathy (p = 0.03). In both groups, body mass index was acceptable in one fifth of patients, and waist circumference in two thirds of men and one third of women (p = NS). Patients with nephropathy used more antihypertensives, particularly angiotensin converting enzyme inhibitors (nephropathy 49% vs. no nephropathy 38%, p = 0.004). Subjects with nephropathy received more frequently (p = 0.05) insulin (11%) than those without nephropathy (7%). In both groups, there was low use of statins (nephropathy 14% vs. no nephropathy 17%, p = 0.23), and aspirin (nephropathy 7% vs. no nephropathy 5%, p = 0.39). Conclusions. Recommended goals for adequate control of DM2 patients attending primary health-care units are rarely achieved, and this was independent of the presence of nephropathy. These findings are disturbing, as poor clinical and metabolic control may eventually cause that patients without nephropathy develop renal damage, and those subjects already with renal disease progress to renal insufficiency.


REFERENCES

  1. United States Renal Data System. http://www.usrds.org/ http:// www.usrds.org (Accessed June, 2007).

  2. Jones CA, Mildred FE, Eberhardt MS, Chavers B, Coresh J, Engelgau M, et al. Microalbuminuria in the US population: third national health and nutrition examination survey. Am J Kidney Dis 2002; 39: 445-59.

  3. Cueto-Manzano AM, Cortés-Sanabria L, Martínez-Ramírez HR, Rojas-Campos E, Barragan G, Alfaro G, et al. Detection of early nephropathy in Mexican type 2 diabetes mellitus patients. Kidney Int 2005; 68(Suppl. 97): S40-S45.

  4. Sociedad Latino-Americana de Nefrología e Hipertensión. http://slanh.org/registro/informes.asp (Accessed June, 2007).

  5. ERA-EDTA Registry. ERA-EDTA Registry 2003 Annual Report. Academic Medical Center, Amsterdam, The Netherlands, May 2005. http://www.era-edta-reg.org (Accessed June, 2007).

  6. The Australia and New Zealand Dialysis and Transplant Registry: http://www.anzdata.org.au (Accessed June, 2007).

  7. Brien AH, Bejarano GH, García GG, Gómez NB, Hernández RI, Lomelí A, et al. Epidemiología de la Insuficiencia Renal Crónica en Jalisco. Boletín Colegio Jalisciense de Nefrología 2001; 5: 6-8.

  8. The National Kidney Foundation –K/DOQI guidelines. http:// www.kidney.org (Accessed, June 2007).

  9. American Diabetes Association. Standards of medical care in diabetes 2007. Diabetes Care 2007; 30(Suppl. 1): S4-S40.

  10. International Diabetes Federation. Global guidelines for type 2 diabetes. http://www.idf.org (Accessed June, 2007).

  11. International Diabetes Federation (Europe). A desktop guide to type 2 diabetes. http://www.staff.ncl.ac.uk/philip.home/t2dg1999.htm (Accessed June, 2007).

  12. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA 2003; 289: 2560-72.

  13. Executive summary of third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001; 285: 2486-97.

  14. Rossert JA, Wauters JP. Recommendations for the screening and management of patients with chronic kidney disease. Nephrol Dial Transplant 2002; 17(Suppl 1): 19-28.

  15. Hebert LA, William A, Wilmer WA, Falkenhain ME, Ladson- Wofford SE, Stanley N, et al. Renoprotection: one or many therapies? Kidney Int 2001; 59: 1211-26.

  16. Barkis GL, Williams M, Dworkin L, Elliot WJ, Epstein M, Toto R, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. Am J Kidney Dis 2000; 36: 646-61.

  17. Nissenson AR, Collins AJ, Hurley J, Petersen H, Pereira BJ, Steinberg E. Opportunities for improving the care of patients with chronic renal insufficiency: current practice patterns. J Am Soc Nephrol 2001; 12: 1713-20.

  18. Pommer W, Bressel F, Chen F, Molzahn M. There is room for improvement of preterminal care in diabetic patients with endstage renal failure –The epidemiological evidence in Germany. Nephrol Dial Transplant 1997; 12: 1318-20.

  19. Tonelli M, Bohm C, Pandeya S, Gill J, Levin A, Kiberd B. Cardiac risk factors and the use of cardioprotective medications in patients with chronic renal insufficiency. Am J Kidney Dis 2001; 37: 484-9.

  20. Resnick HE, Foster GL, Bardsley J, Ratner RE. Achievement of American Diabetes Association clinical practice recommendations among US adults with diabetes, 1999-2002. The National Health and Nutrition Examination Survey. Diabetes Care 2006; 29: 531-7.

  21. Israni A, Korzelius C, Townsend R, Mesler D. Management of chronic kidney disease in an academic primary care clinic. Am J Nephrol 2003; 23: 47-54.

  22. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2007; 30(Suppl. 1): S42-S47.

  23. Levey AS, Greene T, Kusek JW, Beck GJ, MDRD Study Group. A simplified equation to predict glomerular filtration rate from serum creatinine (abstract A0828). J Am Soc Nephrol 2000; 11: 155A.

  24. García de Alba JE, Salcedo RAL, Colunga RC, González BJA, Herrera SE, Milke NME. UISESS scale for staging and classifying clinical-Epidemiological risk in type 2 diabetes mellitus and for establishing multidisciplinary preventive actions. Preventive Medicine 2005; 41: 211-8.

  25. Vásquez-Martínez JL, Gómez-Dantés H, Fernández-Cantón S. Diabetes mellitus en población adulta del IMSS. Resultados de la Encuesta Nacional de Salud 2000. Rev Med Inst Mex Seguro Soc 2006; 44: 13-26.

  26. Aguilar-Salinas CA, Velásquez MO, Gómez-Pérez FJ, González CA, Lara EA, Molina CV, et al. Characteristics of patients with type 2 diabetes in Mexico. Diabetes Care 2003; 26: 2021-6.

  27. Martínez-Ramírez RH, Jalomo-Martínez B, Cortes-Sanabria L, Rojas-Campos E, Barragán G, Alfaro G, et al. Renal function preservation in type 2 diabetes mellitus patients with early nephropathy: a comparative prospective cohort study between primary health care doctors and nephrologist. Am J Kidney Dis 2006; 47: 78-87.

  28. Cortés-Sanabria L, Cabrera-Pivaral CE, Cueto-Manzano AM, Rojas-Campos E, Barragán G, Hernández-Anaya M, Martínez- Ramírez HR. Improving care of patients with diabetes and CKD: A pilot study for a cluster-randomized trial. Am J Kidney Dis 2008; 51: 777-88.

  29. Milos J. Pronóstico. In: Milos J (ed.). Epidemiología: La lógica de la medicina moderna. Barcelona: Editorial Masson; 1996, p. 257-83.

  30. Aguilar-Salinas CA, Olaiz G, Valles V, Rios TJ, Gómez PF, Rull JA, et al. High prevalence of low HDL cholesterol concentrations and mixed hyperlipidemia in a Mexican nationwide survey. J Lipid Res 2001: 42; 1298-307.

  31. Chen J, Munteher P, Hemm L, Jones DW, Batuman V, Fonseca V, et al. The metabolic syndrome and chronic kidney disease in US adults. Ann Inter Med 2004; 140: 167-74.

  32. Peralta CA, Hicks LS, Chertow GM, Ayanian JZ, Vittinghoff E, Lin F, et al. Control of hypertension in adults with chronic kidney disease in the United States. Hypertension 2005; 45: 1119-24.

  33. McClellan WM. Epidemiology and risk factors for chronic kidney disease. Med Clin N Am 2005; 89: 419-45.

  34. Amato D, Alvarez-Aguilar C, Rodriguez E, Avila-Díaz M, Arreola F, Gómez A, et al. Prevalence of chronic kidney disease in urban Mexican population. Kidney Inter 2005; 68(Suppl. 97): S11-S17.

  35. Adler AI, Stevens RJ, Manley SE, Biluos RW, Culi CA, Holman RR. Development of nephropathy and progression in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003; 63: 225-32.

  36. Neugarten J, Acharya A, Silbiger SR. Effect of gender on the progression of nondiabetic renal disease: a meta-analysis. J Am Soc Nephrol 2000; 11: 319-29.

  37. Chuahirun T, Khanna A, Kimball K, Wesson DE. Cigarette smoking and increased urine albumin excretion are interrelated predictors of nephropathy progression in type 2 diabetes. Am J Kidney Dis 2003; 41: 13-21.

  38. Encuesta Nacional de Salud y Nutrición (ENSANUT) 2006. http://www.insp.mx/ensanut/ (Accessed June, 2007).

  39. Lorenzo C, Williams K, Hunt KJ, Heffner SM. The national cholesterol education program-adult treatment panel III, international diabetes federation, and world health organization definitions of metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care 2007; 30: 8-13.

  40. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome-a new worldwide definition. Lancet 2005; 366: 1059-62.

  41. Mogensen CE (ed.). The Kidney and Hypertension y Diabetes Mellitus, 3rd Ed. Norwell: Kluwer Academic Publishers; 1997.




2020     |     www.medigraphic.com