JOURNAL ARTICLE
RESEARCH SUPPORT, NON-U.S. GOV'T
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High-risk diabetic nephropathy patients: the outcome of evidence-based clinical practice in an outpatient clinic.

OBJECTIVE: A retrospective audit to assess the impact of a combined diabetes-renal consultant clinic over 10 years, on slowing the progression of diabetic nephropathy, using recognised markers of renal disease progression, including creatinine clearance and proteinuria.

METHODS: 44 high-risk patients with diabetic nephropathy defined as having significant proteinuria (an elevated albumin creatinine ratio greater than 30 mg/mmol), and hypertension, a progressive rise in plasma creatinine or other evidence of diabetic microvascular disease or macrovascular disease, were identified. Sufficient follow up was defined as at least two data sets over a 12-month period prior to referral to the combined clinic, and at least 18 months of combined clinic follow up thereafter.

RESULTS: In this high risk group, GFR was falling at an average of 7.97 m/min/year (95% CI 9.83-6.10 ml/min/year) at the time of referral and following clinic intervention this was significantly reduced to 3.17 ml/min/year (95% CI 4.47-1.87 ml/min/year) over the duration of follow up. Blood pressure, glycaemic control and lipid status remained stable and close to current recommended guidelines.

CONCLUSIONS: A combined diabetes-renal consultant clinic is an effective intervention to improve the outcome of high-risk diabetics with progressive diabetic nephropathy.

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