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QJM Advance Access published online on February 23, 2006
QJM, doi:10.1093/qjmed/hcl016
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: Journals.permissions@oxfordjournals.org
Received September 23, 2005
Revised January 22, 2006

Original paper

The joint diabetic-renal clinic in clinical practice: 10 years of data from a District General Hospital

M.K. Jayapaul 1 *, R. Messersmith 2, D.N. Bennett-jones 3, P.A. Mead 3, and D.M. Large 1

1 From the Departments of Diabetes and Endocrinology, Cumberland Infirmary, Carlisle, UK
2 From the Departments of Clinical Audit, Cumberland Infirmary, Carlisle, UK
3 From the Departments of Renal Medicine, Cumberland Infirmary, Carlisle, UK

* To whom correspondence should be addressed.
M.K. Jayapaul, E-mail: m.k.jayapaul{at}ncl.ac.uk


  Abstract

Background: Diabetic nephropathy is the leading cause of end-stage renal failure. Untreated, it causes continuous decline in glomerular function, worsening hypertension and a marked increase in cardiovascular risk. Joint diabetic-renal clinics were established to address these factors and prepare patients for renal replacement therapy.

Aim: To determine whether our joint diabetic-renal clinic influenced progression of renal disease, and whether we were able to achieve targets from clinical trials and guidelines in routine practice.

Design: Retrospective review.

Methods: We collected data using clinical notes and electronic records for 130 patients attending the clinic over 10 years.

Results: Our patients had 62% type 2 and 38% type 1 diabetes. Mean duration of diabetes was 24 years for type 1 and 11 years for type 2 diabetes. At referral, 56% had evidence of vascular disease and 45%, proliferative retinopathy. Baseline median creatinine was 124 µmol/l. Significant improvements were made in systolic BP, diastolic BP and cholesterol (p < 0.001), compared to measurements at presentation. We analysed progression of renal disease by linear regression on 45 patients who had follow-up data for 3 years. Rate of decline of GFR was significantly reduced from 1.09 ml/min/month in the first year to 0.39 ml/min/month in the third year, (p < 0.004).

Discussion: Our findings suggest that the rate of deterioration of renal function can be reduced by aggressive management of risk factors. Joint diabetic-renal clinics appear to be useful in achieving targets in routine clinical practice.


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