Although mTOR inhibitor use has been associated with proteinuria in kidney transplant recipients, dose dependency and impact on allograft function are unknown. In a post hoc analysis, we compared rates of proteinuria 3 months posttransplant among everolimus (EVR) and mycophenolate (MPA) treatment arms and used a time-dependent model to correlate the risk of proteinuria to EVR trough levels up to 24 months posttransplant. eGFR and graft loss was compared by proteinuria status at 3 months. Of 833 randomized patients, 24%, 36% and 19% of lower exposure EVR (1.5 mg/day), higher exposure EVR (3.0 mg/day) and MPA-treated patients had proteinuria ≥ 300 mg/g Cr at 3 months, respectively. EVR 1.5 was not associated with an increase in risk of proteinuria (HR 1.20; p = 0.19) unlike EVR 3.0 (HR 1.84; p < 0.001) versus MPA. EVR trough levels >8 ng/mL were significantly associated with proteinuria compared to 3-8 ng/mL (HR 1.86; p < 0.001). Those patients with proteinuria at 3 months and those who developed proteinuria thereafter had lower eGFR and higher graft loss at 24 months, regardless of treatment arm. We identify a dose-dependent effect of EVR with the risk of proteinuria; however, its independent impact upon eGFR and graft survival at 2 years was not evident.

RESULTS:A total of 1185 established T2DM patients were assessed. The mean (SD) age was 55 (10) years and mean duration of diabetes (SD) of 10 (7) years. Metformin was the most commonly prescribed drug [827 (70%)], in general followed by insulin [627 (53%)], sulfonylureas [520 (44%)], and pioglitazone [329 (28%)]. A total of 348 (29%) patients received monotherapy and 837 (71%) received combination therapy. The most frequently prescribed monotherapy was insulin [214 (62%)], followed by metformin in 81 (23%), sulfonylurea in 49 (14%) and pioglitazone in 4 (1%) patients. Family history(OR 1.76, 95%CI 1.18, 2.64), diabetes duration (OR 2.62, 95% CI 2.05, 3.36), Hb A1c (OR 1.25, 95%CI 1.01, 1.50), neuropathy(OR 1.57, 95% CI, 1.14, 2.2), nephropathy(OR 1.77, 95% CI 1.40, 2.24), retinopathy (OR 1.97, 95% CI 1.63, 2.40), Coronary Artery Disease (CAD) (OR 1.57, 95% CI, 1.14, 2.2) and diabetic foot t (OR 1.62, 95% CI 1.12, 2.40) were all significantly associated with the insulin therapy. Obese and overweight patients were prescribed oral antidiabetic drugs. [metformin (OR 1.25, 95% CI 1.15, 1.35), sulfonylurea (OR 1.28, 95% CI 1.01, 1.61)]. CONCLUSIONS: This study finding indicates that medication use was consistent with evidence based practice guidelines in T2DM. There was, however, scope for improvement in prescribing, especially in the T2DM patients with complications. OBJECTIVES:There is a growing interest in the use of electronic medical records (EMRs) for clinical research. The study describes a collaborative research project that uses an EMR database to explore the level of diabetic care in patients with type 2 diabetes in a primary care setting. METHODS: A retrospective study was conducted using the GE Centricity electronic medical records (EMR) database of a primary care physicians group. Patients with type 2 diabetes were identified using ICD-9 codes of 250.xx (January 1, 2004 to March 31, 2009. Patients Ͼ 18 years of age, with two or more visits with their respective physicians, and having an active status in the database were selected. Demographic characteristics, clinical parameters (HbA1c, LDL, HDL) medication use, and number of office visits were identified. Data was extracted using Microsoft SQL and descriptive statistical analyses were conducted using SPSS version 18.0. RESULTS: The study identified 4,598 patients (mean age: 67ϩ 12.9 years and males: 51.8%) with type 2 diabetes. A total of 24,590 office visits were recorded with a mean of 14.1 visits and 127 days between visits. 3,100 (61.3%) patients had HbA1c levels Ͻ 7; 1,473 (29.1%) patients had levels between 7-9; and 484 (9.6%) patients had levels Ͼ 9. 3,970 (59.2%) patients had LDL below 100 mg/dL and 2,737 (40.8%) had LDL greater than 100 mg/dL. Mean number of active medications were 2.34 and diabetes medications were 1.94. Combination drugs were used the most compared with amino acid derivatives and amylin analogs. CONCLUSIONS: The collaborative research project has been established between clinicians and researchers, a baseline data extraction ha...

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