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The joint diabetic-renal clinic in clinical practice: 10 years of data from a District General Hospital

Lookup NU author(s): Dr Muthu Jayapaul


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Background: Diabetic nephropathy is the leading cause of end-stage renal failure. Untreated, it causes continuous decline in glomerular function, worsening hypertension and a marked increase in cardiovascular risk. Joint diabetic-renal clinics were established to address these factors and prepare patients for renal replacement therapy. Aim: To determine whether our joint diabetic-renal clinic influenced progression of renal disease, and whether we were able to achieve targets from clinical trials and guidelines in routine practice. Design: Retrospective review. Methods: We collected data using clinical notes and electronic records for 130 patients attending the clinic over 10 years. Results: Our patients had 62% type 2 and 38% type 1 diabetes. Mean duration of diabetes was 24 years for type 1 and 11 years for type 2 diabetes. At referral, 56% had evidence of vascular disease and 45%, proliferative retinopathy. Baseline median creatinine was 124 μmol/l. Significant improvements were made in systolic BP, diastolic BP and cholesterol (p< 0.001), compared to measurements at presentation. We analysed progression of renal disease by linear regression on 45 patients who had follow-up data for 3 years. Rate of decline of GFR was significantly reduced from 1.09ml/min/month in the first year to 0.39ml/ min/month in the third year, (p <0.004). Discussion: Our findings suggest that the rate of deterioration of renal function can be reduced by aggressive management of risk factors. Joint diabetic-renal clinics appear to be useful in achieving targets in routine clinical practice. © 2006 Oxford University Press.

Publication metadata

Author(s): Jayapaul MK, Messersmith R, Bennett-Jones DN, Mead PA, Large DM

Publication type: Review

Publication status: Published

Journal: QJM - Monthly Journal of the Association of Physicians

Year: 2006

Volume: 99

Issue: 3

Pages: 153-160

ISSN (print): 1460-2725

ISSN (electronic): 1460-2393


DOI: 10.1093/qjmed/hcl016

PubMed id: 16497849