Long-term effectiveness of a community-based model of care in Māori and Pacific patients with type 2 diabetes and chronic kidney disease: a 4-year follow up of the DElay Future End Stage Nephropathy due to Diabetes ( DEFEND) study.

Autor:	Tan, J., Manley, P., Gamble, G., Collins, J., Bagg, W., Hotu, C., Braatvedt, G.
Předmět:	DIABETIC nephropathies TYPE 2 diabetes treatment ACADEMIC medical centers ASIANS CHI-squared test CHRONIC kidney failure COMMUNITY health services HEMODIALYSIS HOSPITAL care HYPERTENSION LONGITUDINAL method MAORI (New Zealand people) MORTALITY HEALTH outcome assessment REHABILITATION SURVIVAL T-test (Statistics) RANDOMIZED controlled trials RETROSPECTIVE studies DATA analysis software KAPLAN-Meier estimator MANN Whitney U Test THERAPEUTICS
Zdroj:	Internal Medicine Journal; Aug2015, Vol. 45 Issue 8, p843-849, 7p, 2 Charts, 1 Graph
Abstrakt:	Background/Aim The Delay Future End Stage Nephropathy due to Diabetes study was a randomised controlled trial of Māori and Pacific patients with advanced diabetic nephropathy, comparing a community-based model of care with usual care. The intervention group achieved lower blood pressure ( BP), proteinuria and less end-organ damage. After the intervention ended, all patients reverted to usual care, and were followed to review the sustainability of the intervention. Methods A retrospective observation of 65 patients (aged 47-75 years) with type 2 diabetes, hypertension, chronic kidney disease 3/4 and proteinuria (>0.5 g/day) previously randomised to intervention/community care or usual care for 11-21 months. Follow up thereafter was until death, end-stage renal disease ( ESRD) (estimated glomerular filtration rate (e GFR) ≤ 10 mL/min/1.73 m2)/dialysis or 1 February 2014. Primary end-points were death and ESRD/dialysis. Secondary outcomes were annualised glomerular filtration rate decline, non-fatal vascular events and hospitalisations. Results Median (interquartile ranges ( IQR)) post-trial follow up was 49 (21-81) months and similar in both groups. The median ( IQR) eGFR decline was −3.1 (−5.5, −2.3) and −5.5 (−7.1, −3.0) mL/min/year in the intervention and usual care groups respectively ( P = 0.11). Similar number of deaths, renal and vascular events were observed in both groups. At the end of follow up, the number of prescribed antihypertensive medications was similar (3.4 ± 1.0 vs 3.3 ± 1.4; P = 0.78). There were fewer median ( IQR) hospital days (8 (3, 18) vs 15.5 (6, 49) days, P = 0.03) in the intervention group. Conclusions Short-term intensive BP control followed by usual care did not translate into reduction in long-term mortality or ESRD rates, but was associated with reduced hospitalisations. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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