Legacy effect in combined diabetic-renal multifactorial intervention in patients with advanced diabetic nephropathy

• Published in: Journal of diabetes and its complications 2018-05, Vol.32 (5), p.474-479
• Main Authors: Kuzhively, Jose, Tahsin, Bettina, Hart, Peter, Fogelfeld, Leon
• Format: Article
• Language: English
• Subjects: Advanced diabetic nephropathy; Chronic disease management; Diabetes; Diabetes co-morbidities; Diabetic nephropathy; Insulin; Intervention; Laboratories; Legacy effect; Mortality; Multidisciplinary-multifactorial care; Multivariate analysis
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2018.02.001

Evaluate legacy effect on renal outcomes after the end of a multifactorial-multidisciplinary intervention in patients with advanced diabetic nephropathy (ADN trial) CKD 3–4. A retrospective electronic review was conducted of 72 patients who completed the ADN trial ESRD-free with subsequent follow-up of two years or until ESRD development. At baseline, reflecting ADN trial end, 38 post-intervention and 34 post-control patients were similar except for lower HbA1c, SBP and age in the post-intervention group. In post-trial follow-up, ESRD developed in both groups at similar rates (23 vs 20%). ESRD occurred mainly in baseline CKD 4 (75%). In CKD 3, only those in post-control developed ESRD (28.6%, p = 0.067). A significant decline in eGFR occurred within both groups. In multivariate analyses, ESRD was associated with baseline yearly eGFR decline. Greater yearly eGFR decline was associated with higher albumin/creatinine ratio at follow-up, lower age, and baseline SBP not being at target (p = 0.005, with an R2 of 0.197). There was no significant post-intervention effect on ESRD progression in the two groups. Minimal legacy effect was observed in less advanced nephropathy (CKD 3). These renal and risk outcomes emphasize the importance and potential benefits of continuous and long-term multifactorial care.