MONITORING THE PROGRESSION OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH DIABETIC NEPHROPATHY- A PERMANENT CHALLENGE

Abstract

Aim of study – The monitoring of renal function in 2 statistically comparative groups of patients, first group with diabetic kidney disease (DKD) and the second with non- diabetics patients with the same degree of chronic kidney disease (CKD). Materials and methods – The prospective study was based on data collected from 785 patients hospitalized in the interval January 2006 - December 2010, 316 of them diagnosed with moderate CKD (creatinine clearance = 30-60 ml/min/1.73 sqm). Two statistically comparative groups of 70 patients were each chosen to continue our study, first group with DKD and the second, non-diabetics with the same degree of CKD. Results. CKD particularly affected the males, especially between 50-70 years old for the first group and 40-60 years old for the second group. The decline of GFR was about 7.8±3.8 ml/min/year for the diabetic patients and about 5.9±2.9 ml/min/year for the non-diabetics. The quarterly referral to nephrologists was better for diabetics (56% vs 24%). The most frequent co-morbidities were detected in diabetics: ischemic heart disease (57% vs 33%), arterial hypertension (90% vs 76%), congestive heart failure (28% vs 12%, p<0.03). The use of renoprotective therapy was more frequent in diabetics: ACEI (54% vs 35%), angiotensin II blockers (24% vs 13%) and statines (77% vs 60%). Almost 10% of our patients died during the study, 60% from the diabetic group. Conclusions – The decline of renal function was more rapid in diabetics with moderate CKD, than in non-diabetics, with almost 3 ml/min/year. Renoprotective therapy is still insufficiently used in diabetic patients and metabolic control is hard to achieve, but the increased referral to nephrologists of this special group of patients makes their monitoring a permanent challenge.