Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK.
Clin Med (Lond). 2013 Oct;13(5):460-4. doi: 10.7861/clinmedicine.13-5-460.
Care of patients with diabetes and chronic kidney disease (CKD) in the UK is divided between primary care, diabetologists and nephrology. In a retrospective analysis, we examined the distribution of care provision for patients with diabetes and CKD. Nephrology services see a minority of diabetic patients with CKD, but they see the majority of those with an estimated glomerular filtration rate (eGFR) of <30 ml/min. Of those followed in nephrology, 70% showed no evidence of progressive renal dysfunction. The nephrology cohort were significantly younger that those seen by primary care physicians or diabetologists. Half of the patients with diabetes and CKD seen in either the primary care and diabetology cohorts, with no nephrology input, had a rate of fall of eGFR of >5 ml/min/yr. This suggests that older age might deter referral to nephrology, which is based predominantly on CKD stage. This results in a significant proportion of patients with stable renal function being seen by nephrology, and in the under-referral of a large cohort of patients with progressive CKD.
在英国，糖尿病和慢性肾脏病（CKD）患者的护理由初级保健、糖尿病专家和肾病科医生共同负责。在一项回顾性分析中，我们研究了糖尿病和 CKD 患者的护理提供情况。肾病科服务仅为少数患有 CKD 的糖尿病患者提供服务，但他们为大多数 eGFR<30ml/min 的患者提供服务。在接受肾病科治疗的患者中，有 70%的患者没有出现肾功能进行性下降的证据。与初级保健医生或糖尿病专家就诊的患者相比，肾病科就诊的患者明显更年轻。在初级保健和糖尿病科就诊的 CKD 患者中，有一半患者在没有接受肾病科治疗的情况下 eGFR 下降率>5ml/min/yr。这表明，年龄较大可能会阻止患者转诊至肾病科，而肾病科的主要依据是 CKD 分期。这导致了相当一部分肾功能稳定的患者由肾病科进行治疗，而大量进展性 CKD 患者则转诊不足。
