Clinical Outcomes Among High-Risk Primary Care Patients With Diabetic Kidney Disease

Author:

Bosworth Hayden B.12345,Patel Uptal D.67,Lewinski Allison A.14,Davenport Clemontina A.8,Pendergast Jane8,Oakes Megan1,Crowley Matthew J.29,Zullig Leah L.12,Patel Sejal3,Moaddeb Jivan10,Miller Julie1,Malone Shauna1,Barnhart Huiman8,Diamantidis Clarissa J.136

Affiliation:

1. Department of Population Health Sciences, Duke University, Durham, NC

2. Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC

3. Division of General Internal Medicine, Duke University School of Medicine, Durham, NC

4. School of Nursing, Duke University, Durham, NC

5. Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC

6. Division of Nephrology, Duke University School of Medicine, Durham, NC

7. Gilead Sciences, Inc., Foster City, CA

8. Department of Biostatistics and Bioinformatics, Durham, NC

9. Division of Endocrinology, Durham, NC

10. Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC

Abstract

Background/Objective: Slowing the progression of diabetic kidney disease (DKD) is critical. We conducted a randomized controlled trial to target risk factors for DKD progression. Methods: We evaluated the effect of a pharmacist-led intervention focused on supporting healthy behaviors, medication management, and self-monitoring on decline in estimated glomerular filtration rate (eGFR) for 36 months compared with an educational control. Results: We randomized 138 individuals to the intervention group and 143 to control. At baseline, mean (SD) eGFR was 80.7 (21.7) mL/min/1.73m2, 56% of participants had chronic kidney disease and a history of uncontrolled hypertension with a baseline SBP of 134.3 mm Hg. The mean (SD) decline in eGFR by cystatin C from baseline to 36 months was 5.0 (19.6) and 5.9 (18.6) mL/min/1.73m2 for the control and intervention groups, respectively, with no significant between-group difference (P=0.75). Conclusions: We did not observe a significant difference in clinical outcomes by study arm. However, we showed that individuals with DKD will engage in a pharmacist-led intervention. The potential explanations for a lack of change in DKD risk factors can be attributed to 5 broad issues, challenges: (1) associated with enrolling patients with low eGFR and poor BP control; (2) implementing the intervention; (3) limited duration during which to observe any clinical benefit from the intervention; (4) potential co-intervention or contamination; and (5) low statistical power.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference21 articles.

1. Diabetic kidney disease: world wide difference of prevalence and risk factors;Gheith;J Nephropharmacol,2015

2. Diabetic kidney disease: a report from an ADA Consensus Conference;Tuttle;Am J Kidney Dis,2014

3. Health inequities and the inappropriate use of race in nephrology;Eneanya;Nat Rev Nephrol,2022

4. Multidisciplinary management of diabetic kidney disease: a systematic review and meta-analysis;Helou;JBI Database System Rev Implement Rep,2016

5. Intensified multifactorial intervention in type 2 diabetics with microalbuminuria leads to long-term renal benefits;Oellgaard;Kidney Int,2017

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