BACKGROUND: Chronic kidney disease is common in Pasifika people with type 2 diabetes. Lowering blood pressure (BP) and reducing proteinuria may slow the rate of progression of renal disease. METHOD: We conducted a 2-year study in patients with type 2 diabetes with estimated glomerular filtration rate (eGFR) greater than or equal to 40 ml/mmin/1.73 m² and urinary albumin-creatinine ratio (ACR) greater than or equal to 40 mg/mmol to evaluate a community-based programme aimed at optimising BP. Primary outcomes included BP reduction, remission of albuminuria and change in eGFR. RESULTS: Thirty-nine of 47 patients completed greater than or equal to 17 months of intervention. The mean age was 53 plus or minus 8 years; 77% were male. An increase in antihypertensive therapy intensity was accompanied by a median (IQR) reduction in BP of 13[-1.5-22.5)/ 12(1-19) mmHg p<0.05] and urinary ACR (51(20-97) vs. 126(65-194) mg/mmol, p<0.05). Twelve (28%) of 43 patients achieving remission of albuminuria had a faster eGFR loss in the first year compared to the non-remitting group [13.6(4.0-16.6) vs. 3.5(-0.97-7.5) ml/min/1.73 m²/year, (p=0.02), but the rate of loss slowed in the second year. Two patients reached ESRF. CONCLUISON: This community-based programme was effective in lowering BP and urinary ACR. In patients who achieved remission of albuminuria, a slower eGFR decline was observed after 12 months.
BACKGROUND: Chronic kidney disease is common in Pasifika people with type 2 diabetes. Lowering blood pressure (BP) and reducing proteinuria may slow the rate of progression of renal disease. METHOD: We conducted a 2-year study in patients with type 2 diabetes with estimated glomerular filtration rate (eGFR) greater than or equal to 40 ml/mmin/1.73 m² and urinary albumin-creatinine ratio (ACR) greater than or equal to 40 mg/mmol to evaluate a community-based programme aimed at optimising BP. Primary outcomes included BP reduction, remission of albuminuria and change in eGFR. RESULTS: Thirty-nine of 47 patients completed greater than or equal to 17 months of intervention. The mean age was 53 plus or minus 8 years; 77% were male. An increase in antihypertensive therapy intensity was accompanied by a median (IQR) reduction in BP of 13[-1.5-22.5)/ 12(1-19) mmHg p<0.05] and urinary ACR (51(20-97) vs. 126(65-194) mg/mmol, p<0.05). Twelve (28%) of 43 patients achieving remission of albuminuria had a faster eGFR loss in the first year compared to the non-remitting group [13.6(4.0-16.6) vs. 3.5(-0.97-7.5) ml/min/1.73 m²/year, (p=0.02), but the rate of loss slowed in the second year. Two patients reached ESRF. CONCLUISON: This community-based programme was effective in lowering BP and urinary ACR. In patients who achieved remission of albuminuria, a slower eGFR decline was observed after 12 months.
Authors: Marie-Eve Poitras; Vanessa T Vaillancourt; Amanda Canapé; Amélie Boudreault; Kate Bacon; Sharon Hatcher Journal: Fam Med Community Health Date: 2022-05
Authors: Rachel Reilly; Katharine Evans; Judith Gomersall; Gillian Gorham; Micah D J Peters; Steven Warren; Rebekah O'Shea; Alan Cass; Alex Brown Journal: BMC Health Serv Res Date: 2016-04-06 Impact factor: 2.655
Authors: Celia C Kamath; Claudia C Dobler; Rozalina G McCoy; Michelle A Lampman; Atieh Pajouhi; Patricia J Erwin; John Matulis; Muhamad Elrashidi; Joseph Darcel; Mouaz Alsawas; Zhen Wang; Nilay D Shah; M Hassan Murad; Bjorg Thorsteinsdottir Journal: J Gen Intern Med Date: 2020-10-26 Impact factor: 5.128