Chronic kidney disease and diabetes in the National Health Service: a cross‐sectional survey of the UK National Diabetes Audit. Issue 4 (1st October 2013)

• Record Type: Journal Article
• Authors: Hill, C. J.; Cardwell, C. R.; Patterson, C. C.; Maxwell, A. P.; Magee, G. M.; Young, R. J.; Matthews, B.; O'Donoghue, D. J.; Fogarty, D. G.
• Is Part Of: Diabetic medicine. Volume 31:Issue 4(2014:Apr.)
• Page Start: 448
• Page End: 454
• Publication Date: 2013-10-01
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12312
• Languages: English
• ISSNs: 0742-3071

Abstract

<abstract abstract-type="main" id="dme12312-abs-0001"> <title>Abstract</title> <sec id="dme12312-sec-0001" sec-type="section"> <title>Aims</title> <p>We investigated the prevalence of chronic kidney disease and attainment of therapeutic targets for HbA<sub>1c</sub> and blood pressure in a large UK‐based diabetes population.</p> </sec> <sec id="dme12312-sec-0002" sec-type="section"> <title>Methods</title> <p>The UK National Diabetes Audit provided data from 1 January 2007 to 31 March 2008. Inclusion criteria were a documented urinary albumin:creatinine ratio and serum creatinine. Patients were stratified according to chronic kidney disease stage and albuminuria status. Chronic kidney disease was defined as an estimated glomerular filtration rate < 60 ml min<sup>−1</sup> 1.73 m<sup>−2</sup>, albuminuria or both. The proportions of patients achieving nationally defined glycaemic and systolic blood pressure targets were determined.</p> </sec> <sec id="dme12312-sec-0003" sec-type="section"> <title>Results</title> <p>The cohort comprised 1 423 669 patients, of whom 868 616 (61%) met inclusion criteria. Of the patients analysed, 92.2% had Type 2 diabetes. A higher proportion of people with Type 2 diabetes (42.3%) had renal dysfunction compared with those with Type 1 diabetes (32.4%). Achievement of systolic blood pressure and HbA<sub>1c</sub> targets was poor. Among people with Type 1 diabetes, 67.8% failed to achieve an HbA<sub>1c</sub> < 58 mmol/mol (7.5%). Of all people with diabetes, 37.8% failed to achieve a systolic blood pressure < 140 mmHg. Blood pressure control was poor in advanced chronic kidney disease. For example, mean (standard deviation) systolic blood pressure rose from 128.6 (15.4) mmHg among people with Type 1 diabetes and normal renal function to 141.0 (23.6) mmHg in those with chronic kidney disease stage 5 and macroalbuminuria.</p> </sec> <sec id="dme12312-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The high prevalence of chronic kidney disease and poor attainment of treatment targets highlights a large subset of the diabetes population at increased risk of cardiovascular mortality or progressive kidney disease.</p> </sec> </abstract>