Influence of Referral to a Combined Diabetology and Nephrology Clinic on Renal Functional Trends and Metabolic Parameters in Adults With Diabetic Kidney Disease

• Published in: Mayo Clinic proceedings. Innovations, quality & outcomes Vol. 1; no. 2; pp. 150 - 160
• Main Authors: Martin, William P., Griffin, Tomás P., Lappin, David W., Griffin, Damian G., Ferguson, John P., O'Brien, Timothy, Griffin, Matthew D.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-09-2017; Elsevier
• Subjects: Original; eGFR; BSA; IDMS; DRC; T1D; T2D; DM; DKD; CKD; CKD-EPI; HbA1c; MDRD; DKD, diabetic kidney disease; eGFR, estimated glomerular filtration rate; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; BSA, body surface area; DM, diabetes mellitus; HbA1c, glycated hemoglobin; T1D, type 1 DM; IDMS, isotope dilution mass spectrometry; MDRD, modification of diet in renal disease; DRC, diabetes renal clinic; T2D, type 2 DM; CKD, chronic kidney disease
• ISSN: 2542-4548; 2542-4548
• DOI: 10.1016/j.mayocpiqo.2017.07.003

To examine the impact of a diabetes renal clinic (DRC) on renal functional and metabolic indices in adults who have diabetes mellitus (DM) and chronic kidney disease (CKD).
All patients evaluated at a DRC in a single tertiary referral center from January 1, 2008, to December 31, 2012, were identified. Serial renal and metabolic indices from January 1, 2004, to December 31, 2014, were recorded, and trends over time were analyzed by linear mixed-effects models.
A total of 200 patients who had DM and CKD were identified and subdivided into 3 categories based on presumptive CKD etiology: 43 (21.5%) with type 1 DM (T1D) only, 127 (63.5%) with type 2 DM (T2D) only, and 30 (15.0%) with DM and an additional CKD etiology. Average annual absolute (mL/min per body surface area per year) and percentage (%/year) changes, respectively, in Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rate before vs after first DRC attendance were: −1.59 vs −3.10 (P=.31) and −1.22 vs −9.39 (P=.06) for T1D; −5.64 vs −3.07 (P=.004) and −10.88 vs −9.94 (P=.70) for T2D; and −6.50 vs +0.91 (P<.001) and −13.28 vs −2.29 (P=.001) for DM with an additional CKD etiology. Glycemic control worsened in those who had T2D, whereas trends in total cholesterol levels improved in those who had T1D.
After first DRC attendance, the absolute rate of estimated glomerular filtration rate decline remained similar for those who had T1D, but it slowed for those who had T2D or DM with additional CKD etiology. Thus, benefits of combined diabetology and nephrology consultation may vary for different diabetic subpopulations.