Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: Important differences between practice and published guidelines

McClellan, William M.; Knight, Dawn F.; Karp, Herbert R.; Brown, Wendy Weinstock

doi:10.1016/s0272-6386(97)90197-9

Cited by 129 publications

(79 citation statements)

References 20 publications

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“…These results are in agreement with previous reports on the management of hypertension in both diabetic and nondiabetic subjects. [19][20][21][22][23][24][25][26][27] In particular, systolic hypertension appears inadequately treated and controlled in our cohort despite the fact that the UKPDS study 28 has demonstrated that the incidence of clinical complications and deaths related to diabetes is significantly associated with systolic blood pressure, without evidence of a threshold. Major determinants in the probability of being treated with antihypertensive therapy for a type II diabetic subject with hypertension are the patient compliance, previous fundoscopy, and previous coronary/cerebrovascular events.…”

Section: Discussionmentioning

confidence: 99%

How well are hypertension and albuminuria treated in type II diabetic patients?

et al. 2003

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The purpose of this study was to assess the management of both hypertension and micro/macroalbuminuria in a cohort of type II diabetic patients. In the first 6 months of the year 2000, 5815 diabetic patients were identified through prescriptions for antidiabetic drugs in our sanitary district (191 568 inhabitants). In all, 65% (3810) of these type II diabetic patients were also given prescriptions for antihypertensive drugs. A total of 400 diabetic patients were randomly selected and 171 entered the study (gender: 94/77 M/F; age: 66.6 7 8 years; diabetes duration: 12 7 9 years): 100 patients (group DT) were treated with antihypertensive drugs and 71 (group DU) were untreated. Blood pressure, urine albumin-to-creatinine ratio (ACR), and glycated haemoglobin were measured in the two groups. A total of 80% (57/71) of DU patients were hypertensive (BPX130/ 85 mmHg). Specifically, 24.4% had diastolic hypertension (BPX85 mmHg) and 79% systolic hypertension (BPX130 mmHg). Only 63% (100/157) of the hypertensive patients were treated with antihypertensive drugs (two drugs/patient on average, range 1-5). In addition, only 13% of the DT patients were adequately controlled (BPo130/85 mmHg), while the others had above target blood pressure levels (14%: 130-139/85-89 mmHg; 40%: 140-159/90-95 mmHg, and 33%X160/ 95 mmHg). Angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) were included in the antihypertensive medical regimen in 70% of the DT patients (ACE-I: 62%; ARB: 8%; diuretics: 39%; dihydropyridine calcium antagonists: 38%; a-blockers: 20%, b-blockers: 17%; clonidin: 8%; nondihydropyridine calcium antagonists: 5%). Only 33% of type II diabetic patients underwent a screening for microalbuminuria as assessed on clinical records. The same percentage of micro-and macroalbuminuric patients (13.5%) was observed in the DT group, whereas 25% micro vs 3% macro were found in the DU group. In all, 73% of microalbuminuric patients were not on ACE-I/ARB. Hypertensive type II diabetic patients were often left untreated and only a minority of those treated were optimally controlled. The importance of an elevated systolic pressure is underestimated and the number of antihypertensive drugs prescribed insufficient. Screening and treatment of albuminuria are inadequate.

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Section: Discussionmentioning

confidence: 99%

How well are hypertension and albuminuria treated in type II diabetic patients?

et al. 2003

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“…Awareness was higher among patients with lower kidney function and higher albuminuria levels. Also, chart review of patients suggests that CKD is often undiagnosed, and associated complications (e.g., anemia) often remain untreated (20,21). These findings further highlight the need to improve early detection and management of CKD in the US population.…”

Section: Ckd As a Public Health Problem In Need Of Early Identificatimentioning

confidence: 99%

Principles of Screening for Chronic Kidney Disease

Jaar¹,

Khatib²,

Plantinga³

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…However, delaying the onset of ESRD is clearly worthwhile. Cost-effective analyses support the economic desirability of early therapy (9). Furthermore, ACE inhibition and BP control will likely preserve other aspects of cardiovascular health.…”

mentioning

confidence: 96%

“…More distressing are the data that patients who have had these tests are often not prescribed the cardinal components of the accepted therapeutic regimen. For example, only about one-third of diabetic patients discharged from hospitals who had proteinuria or elevated serum creatinine were placed on ACE inhibitors (9). An even smaller percentage of those who had hypertension and evidence of renal damage were discharged with prescriptions for ACE inhibitors.…”

mentioning

confidence: 99%

National Kidney Disease Education Program

Hostetter

Lising²

2003

Journal of the American Society of Nephrology

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Abstract. The National Kidney Disease Education Program (NDKEP) is a program of the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health. It seeks to increase awareness of CKD among high risk groups and primary care providers. The NKDEP is a response to the rapidly escalating incidence of ESRD in the United States in the face of new treatment to prevent and mitigate CKD. The hope is that awareness will lead to action, testing, and treatment.The impetus for a National Kidney Disease Education Program (NDKEP) derives from three observations. First, the number of people with ESRD is increasing such that it now represents a significant public health burden. Second, clinically valid approaches for detecting, preventing, and slowing the progression to ESRD are widely available. Third, these approaches are sparsely used in practice.In 2000, approximately 100,000 people were projected to develop ESRD. Adding these people to the prevalent ESRD population yielded a total of about 380,000. Of these, approximately 80,000 were alive with a functioning renal transplant; the remainder were on dialysis. The number of people developing ESRD has doubled each decade for the last two decades with annual increases of 6 to 8%. The projections suggest that over 600,000 people will have ESRD by the year 2010. Because transplantation rates have remained plateaued at around 13,000/yr, the projected 175,000 people developing ESRD in 2010 will essentially all be maintained on one form of dialysis or another (1). Currently, the incidence of ESRD exceeds the death rate from any cancer except lung cancer. Furthermore, with annual mortality for patients on dialysis in the range of 20%, more people die with treated uremia than with any cancer, except for lung cancer. If current trends continue, by 2010, the toll of ESRD will exceed that of lung cancer (2).This burden of disease is paralleled by the enormous cost for delivering ESRD care. The total costs of treating people for ESRD in 1999 were $17.9 billion. This figure includes not only the cost of dialysis, or transplant care, but also the associated medical expenditures incurred by this large patient group. Furthermore, the Centers for Medicare and Medicaid Services (CMS) expends approximately 6% of its entire budget on reimbursements for people with ESRD, whereas those people represent less than 1% of the CMS beneficiaries. For compar-

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Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: Important differences between practice and published guidelines

Cited by 129 publications

References 20 publications

How well are hypertension and albuminuria treated in type II diabetic patients?

How well are hypertension and albuminuria treated in type II diabetic patients?

Principles of Screening for Chronic Kidney Disease

National Kidney Disease Education Program

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