A Pilot Programme on Diabetic Kidney Disease

Abstract Description

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Authors (including presenting author) :

LAU SLT(1), HO HSE(2), LAU YFE(1), MO KL(2), LAW PY(3) , KOT WY(4), LEUNG YYJ(1), LAO WC(1)(2), CHENG B(1)(2)

Affiliation :

(1)HKEC DM and Endocrine Team, (2) Renal Team, Department of MEDICINE, PYNEH, (3) Dietetic Department, PYNEH, (4) Community and Patient Resource Department, PYNEH.

Introduction :

There is an increasing trend of patients with chronic kidney disease (CKD) in Hong Kong. The number of new patients with diabetic nephropathy requiring renal replacement therapy (RRT) increased from 26.2% in 1996 to 53% in 2017. Diabetic Kidney Disease (DKD) is also the leading cause of end stage renal disease (ESRD) worldwide. People with DKD are not only at significant risk of progression to ESRD, they also have increase in cardiovascular morbidity and mortality, frequent hospitalizations related to dialysis, accounted for a considerable healthcare costs.

Objectives :

To explore a multidisciplinary service model to provide early intervention to patients with stage 3 DKD with an aim to delay the progression to RRT

Methodology :

The pilot program was implemented in HKEC-PYNEH from March 2017 onwards. Diabetic patients with following criteria were recruited (1) age 18 to 70 and (2) CKD stage 3 and (3) not follow-up by Renal Team. All attended an empowerment talk (3 hours) with joint collaboration from Nephrologist, Renal Nurse, Diabetes Nurse, Dietitian and Social Worker at first visit. Thereafter, patients aged 18 to 60 (category 1) were arranged to follow-up by Endocrinologists and Diabetes nurse using a structured program for 52 weeks. Patients aged 61 to 70 (category 2) will be arranged for a 2nd and 3rd empowerment talks at week 24 and 52, in addition to usual care. Their renal function, diabetes, blood pressure and metabolic control were closely monitored. Data was collected from medical records. Self-care knowledge questionnaire and satisfactory survey were used for evaluation.

Result & Outcome :

A total of 173 patients were recruited from March to December 2017. Total of 60 patients had completed the 52 week program. Data from 8 patients in category 1 and 52 patients in category 2 were recruited in analysis. HbA1c decreased significantly from 8.4 % to 7.0 % for category 1 (p< 0.009) and from 7.8 % to 7.5 % in category 2 (p< 0.145). For both categories, there is no significant deterioration in renal status in terms of serum creatinine and eGFR, indicating that renal function was being maintained. In addition, blood pressure and body weight were found to be stable in both categories. Participants also showed understanding on their stage of CKD and with increase in awareness of self-care.