Investigation of the Progression and Management of Chronic Kidney Disease in Adult Patients with Diabetes and/or Hypertension

Abstract

Objective: To investigate the rate of progression to stage 4 chronic kidney disease (CKD) in patients with CKD stage 3a and 3b, and the management they received. Method: In this 3-year retrospective study, the electronic databases of 12 health-promoting hospitals in Nakhon Ratchasima Province were used. Patients with diabetes and/or hypertension who were at the age of 18 years or over and had CKD stage 3a and 3b before or during the fiscal year of 2013 were recruited and followed up until the end of the fiscal year of 2015. Results: In 2013, 162 and 142 patients experienced CKD stage 3a and 3b, respectively, but only 6 (3.70%) and 14 (9.86%) of them progressed to stage 4. The progression–free period of CKD stage 4 was 2.42 years. In 2015, 20 of 142 stage 3 CKD patients progressed to stage 4, whereas 122 did not. In terms of disease management for the patients with and without the progression their fasting blood sugar was within the range of 80 – 130 mg% (7.69% vs. 6.00%), HbA1c under 7% (23.08% vs. 40.00%) and blood pressure at 140/90 mmHg or lower (35.00% vs. 40.16%). The number of hypertensive patients with the progression who received angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) was lower than those without the progression (25.00% vs. 51.26%). This result was similar to diabetic patients with micro-albuminuria who took either ACEIs or ARBs (0% vs. 2.00%) and patients aged 50 years or over who received statins (40.00% vs. 58.82%). For laboratory monitoring, all stage 3a patients were tested for the renal function at least once a year, but most patients with stage 3b and 4 were not fully monitored according to the guidelines. None of them were monitored for anemia, acidosis, or mineral and bone disorders. Conclusion: CKD patients with no progression to stage 4 were more likely to receive a better management than those with the progression. All patients however did not obtain the complete standard care. A policy on the effective management of CKD patients by a multidisciplinary team should be developed and implemented. Keywords: chronic kidney disease, disease progression, disease management, diabetes, hypertension