Lamine Faiza, Lalubin Fabrice, Pitteloud Nelly, Burnier Michel, Zanchi Anne
Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne Switzerland; Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Swiss Med Wkly. 2016 Feb 28;146:w14282. doi: 10.4414/smw.2016.14282. eCollection 2016.
The aim of this study was to assess the prevalence of chronic kidney disease (CKD) among type 2 diabetic patients in primary care settings in Switzerland, and to analyse the prescription of antidiabetic drugs in CKD according to the prevailing recommendations.
In this cross-sectional study, each participating physician was asked to introduce anonymously in a web database the data from up to 15 consecutive diabetic patients attending her/his office between December 2013 and June 2014. Demographic, clinical and biochemical data were analysed. CKD was classified with the KDIGO nomenclature based on estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio.
A total of 1 359 patients (mean age 66.5 ± 12.4 years) were included by 109 primary care physicians. CKD stages 3a, 3b and 4 were present in 13.9%, 6.1%, and 2.4% of patients, respectively. Only 30.6% of patients had an entry for urinary albumin/creatinine ratio. Among them, 35.6% were in CKD stage A2, and 4.1% in stage A3. Despite prevailing limitations, metformin and sulfonylureas were prescribed in 53.9% and 16.5%, respectively, of patients with advanced CKD (eGFR <30 ml/min). More than a third of patients were on a dipeptidyl-peptidase-4 inhibitor across all CKD stages. Insulin use increased progressively from 26.8% in CKD stage 1-2 to 50% in stage 4.
CKD is frequent in patients with type 2 diabetes attending Swiss primary care practices, with CKD stage 3 and 4 affecting 22.4% of cases. This emphasizes the importance of routine screening of diabetic nephropathy based on both eGFR and urinary albumin/creatinine ratio, the latter being largely underused by primary care physicians. A careful individual drug risk/benefit balance assessment is mandatory to avoid the frequently observed inappropriate prescription of antidiabetic drugs in CKD patients.
本研究旨在评估瑞士初级医疗环境中2型糖尿病患者慢性肾脏病（CKD）的患病率，并根据现行建议分析CKD患者中抗糖尿病药物的处方情况。
在这项横断面研究中，要求每位参与的医生在网络数据库中匿名录入2013年12月至2014年6月期间在其办公室就诊的最多15例连续糖尿病患者的数据。对人口统计学、临床和生化数据进行分析。根据肾小球滤过率估算值（eGFR）和尿白蛋白/肌酐比值，采用KDIGO命名法对CKD进行分类。
109名初级保健医生共纳入1359例患者（平均年龄66.5±12.4岁）。CKD 3a期、3b期和4期患者分别占13.9%、6.1%和2.4%。只有30.6%的患者有尿白蛋白/肌酐比值记录。其中，35.6%处于CKD A2期，4.1%处于A3期。尽管存在普遍局限性，但在晚期CKD（eGFR<30 ml/min）患者中，分别有53.9%和16.5%的患者使用二甲双胍和磺脲类药物。在所有CKD阶段，超过三分之一的患者使用二肽基肽酶-4抑制剂。胰岛素的使用从CKD 1-2期的26.8%逐渐增加到4期的50%。
在瑞士初级医疗机构就诊的2型糖尿病患者中，CKD很常见，CKD 3期和4期影响22.4%的病例。这强调了基于eGFR和尿白蛋白/肌酐比值进行糖尿病肾病常规筛查的重要性，而后者在初级保健医生中使用严重不足。必须仔细进行个体药物风险/获益平衡评估，以避免CKD患者中常见的抗糖尿病药物不适当处方情况。
