Gardiner Fergus William, Nwose Ezekiel Uba, Bwititi Phillip Taderera, Crockett Judith, Wang Lexin
School of Community Health, Charles Sturt University, Australia; Calvary Hospital, ACT, Australia; School of Biomedical Sciences, Charles Sturt University, Australia.
School of Community Health, Charles Sturt University, Australia.
Diabetes Metab Syndr. 2018 May;12(3):291-300. doi: 10.1016/j.dsx.2017.12.007. Epub 2017 Dec 16.
To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM).
Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence.
Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of <140/90 mmHg. The average CKD patient pre-admission BP was 134.8/72.2 mmHg compared to the discharge BP of 129.8/72.2 mmHg. At admission, 63.3% and 93.1% of patients adhered to systolic and diastolic BP recommendations, which significantly (p = < .05) increased at discharge to a systolic and diastolic BP adherence of 83.9% and 98.8%, respectively. The average random hospital BGL was 7.7 mmol/L, indicating good control, whereas the pre-hospital HbA1c average was 7.58%, indicating poor control (>7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = <.05) between clinical inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%).
Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment.
确定慢性肾脏病（CKD）患者的血压（BP）目标值（<140/90 mmHg）和随机血糖水平（BGL）目标值（<7.7 mmol/L）的控制达成程度；以及临床惰性对CKD和糖尿病（DM）患者血压和血糖控制的影响程度。
收集2015年1月1日至2015年12月31日期间有关患者主要病理、入院原因、最终出院诊断以及临床指南遵循情况的信息。
纳入了87例CKD患者。所有CKD患者的平均住院血压为134.3/73.4 mmHg，符合<140/90 mmHg的推荐值。CKD患者入院前的平均血压为134.8/72.2 mmHg，出院时血压为129.8/72.2 mmHg。入院时，63.3%和93.1%的患者符合收缩压和舒张压的推荐值，出院时显著（p = <.05）提高，收缩压和舒张压的符合率分别为83.9%和98.8%。住院时随机血糖平均水平为7.7 mmol/L，表明控制良好，而院前糖化血红蛋白平均水平为7.58%，表明控制不佳（>7.0% >53 mmol/mol）。有21例临床惰性情况，影响了87例患者中的18例（20.7%），临床惰性患者与非临床惰性患者的收缩压（144.2对132.8 mmHg）、血糖紊乱（66.7%对35.3%）以及肾功能下降（83.3%对30.9%）在出院时有显著差异（p = <.05）。
遵循情况似乎与住院临床惰性以及门诊患者的健康素养和自主能力有关。
