慢性肾脏病(CKD)是2型糖尿病(T2D)的一种通常无症状的并发症,需要每年进行筛查才能诊断。与筛查和治疗不足相关的患者水平因素可以为实施策略提供信息,以促进指南推荐的CKD护理。
■确定T2D患者与指南推荐的CKD筛查和治疗不一致的危险因素。
这项回顾性队列研究在20个卫生保健系统中进行,为美国国家以患者为中心的临床研究网络提供数据。为了评估与CKD筛查指南的一致性,纳入了在2015年1月1日至2020年12月31日期间进行了与T2D诊断相关的门诊临床医师就诊,且无已知CKD的成人.一项单独的分析回顾了CKD成人的血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体阻滞剂(ARBs)和钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂的处方(估计肾小球滤过率[eGFR]为30-90mL/min/1.73m2和尿白蛋白与肌酐比率[UACR]为200-5000mg/g),以及2019年12月1日与T2D数据从2022年7月8日至2023年6月22日进行了分析。
■人口统计,生活方式因素,合并症,药物,和实验室结果。
■筛查需要在指诊后15个月内测量肌酐水平和UACR。治疗反映了在索引访视前12个月或后6个月内ACEI或ARB和SGLT2抑制剂的处方。
■在316234名成年人中评估了与CKD筛查指南的一致性(平均年龄,59[IQR,50-67]年),其中51.5%是女性;21.7%,黑色;10.3%,西班牙裔;67.6%,白只有24.9%的人接受了肌酐和UACR筛查,56.5%接受了1次筛查测量,18.6%的人都没有收到。西班牙裔种族与缺乏筛查相关(相对风险[RR],1.16[95%CI,1.14-1.18])。相比之下,心力衰竭,外周动脉疾病,高血压与不一致的风险较低相关.在4215例CKD和蛋白尿患者中,3288(78.0%)接受了ACEI或ARB;194(4.6%),SGLT2抑制剂;和885(21.0%),都不是治疗。外周动脉疾病和较低的eGFR与缺乏CKD治疗有关,而利尿剂或他汀类药物处方和高血压与治疗相关。
■在这项T2D患者的队列研究中,不到1/4的患者接受了推荐的CKD筛查.在CKD和蛋白尿患者中,21.0%没有接受SGLT2抑制剂或ACEI或ARB,尽管有令人信服的迹象。患者水平的因素可以告知实施策略,以改善T2D患者的CKD筛查和治疗。
UNASSIGNED: Chronic kidney disease (CKD) is an often-asymptomatic complication of type 2 diabetes (T2D) that requires annual screening to diagnose. Patient-level factors linked to inadequate screening and treatment can inform implementation strategies to facilitate
guideline-recommended CKD care.
UNASSIGNED: To identify risk factors for nonconcordance with
guideline-recommended CKD screening and treatment in patients with T2D.
UNASSIGNED: This retrospective cohort study was performed at 20 health care systems contributing data to the US National Patient-Centered Clinical Research Network. To evaluate concordance with CKD screening
guidelines, adults with an outpatient clinician visit linked to T2D diagnosis between January 1, 2015, and December 31, 2020, and without known CKD were included. A separate analysis reviewed prescription of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in adults with CKD (estimated glomerular filtration rate [eGFR] of 30-90 mL/min/1.73 m2 and urinary albumin-to-creatinine ratio [UACR] of 200-5000 mg/g) and an outpatient clinician visit for T2D between October 1, 2019, and December 31, 2020. Data were analyzed from July 8, 2022, through June 22, 2023.
UNASSIGNED: Demographics, lifestyle factors, comorbidities, medications, and laboratory results.
UNASSIGNED: Screening required measurement of creatinine levels and UACR within 15 months of the index visit. Treatment reflected prescription of ACEIs or ARBs and SGLT2 inhibitors within 12 months before or 6 months following the index visit.
UNASSIGNED: Concordance with CKD screening
guidelines was assessed in 316 234 adults (median age, 59 [IQR, 50-67] years), of whom 51.5% were women; 21.7%, Black; 10.3%, Hispanic; and 67.6%, White. Only 24.9% received creatinine and UACR screening, 56.5% received 1 screening measurement, and 18.6% received neither. Hispanic ethnicity was associated with lack of screening (relative risk [RR], 1.16 [95% CI, 1.14-1.18]). In contrast, heart failure, peripheral arterial disease, and hypertension were associated with a lower risk of nonconcordance. In 4215 patients with CKD and albuminuria, 3288 (78.0%) received an ACEI or ARB; 194 (4.6%), an SGLT2 inhibitor; and 885 (21.0%), neither therapy. Peripheral arterial disease and lower eGFR were associated with lack of CKD treatment, while diuretic or statin prescription and hypertension were associated with treatment.
UNASSIGNED: In this cohort study of patients with T2D, fewer than one-quarter received recommended CKD screening. In patients with CKD and albuminuria, 21.0% did not receive an SGLT2 inhibitor or an ACEI or an ARB, despite compelling indications. Patient-level factors may inform implementation strategies to improve CKD screening and treatment in people with T2D.