Bayer AG, Wuppertal, Germany.
Aetion, Inc., Boston, MA.
Mayo Clin Proc. 2021 Apr;96(4):975-986. doi: 10.1016/j.mayocp.2020.07.037. Epub 2021 Mar 12.
To examine the screening rates for kidney damage and function among patients with type 2 diabetes (T2D) and chronic kidney disease stage at diabetes diagnosis using a US administrative claims database.
This cohort study used a claims database enriched with laboratory results data. Patients with T2D (defined as 1 inpatient or 2 outpatient claims for diabetes), aged 18 years or older, and with at least 1 year of follow-up enrollment were identified. Patients with type 1 diabetes, kidney disease, or other related conditions at baseline were excluded. We estimated screening rates using laboratory orders for serum creatinine and estimated glomerular filtration rate (eGFR) measurement and urine albumin to creatinine ratio (UACR). Chronic kidney disease severity was reported using the Kidney Disease: Improving Global Outcomes classification based on laboratory results.
A total of 1,881,447 patients with T2D were eligible for analysis. Mean ± SD age was 63.1±13.1 years; 947,150 patients (50.3%) were male. Serum creatinine tests were ordered within 14 days of the index date among 290,722 patients of 622,915 (46.7%) patients with newly-recognized T2D. Overall, 1,595,964 patients (84.8%) had at least one serum creatinine test ordered during the 1-year follow-up period. Fewer patients received a UACR test during follow-up (814,897 [43.3%]). Less than half of all patients with T2D received a laboratory test order for both serum creatinine and urine albumin measurements during the follow-up period.
Physicians treating patients with diabetes are selectively adhering to chronic kidney disease screening guidelines, as indicated by high rates of eGFR testing, but less frequent UACR testing. Despite recommendations to monitor both eGFR and UACR, less than half of patients were screened for albuminuria during the 1-year follow-up.
利用美国行政索赔数据库，检查在诊断糖尿病时患有 2 型糖尿病（T2D）和慢性肾脏病（CKD）阶段的患者的肾脏损伤和功能的筛查率。
本队列研究使用了一个丰富的实验室结果数据的索赔数据库。确定了患有 T2D（定义为 1 次住院或 2 次门诊糖尿病就诊）、年龄在 18 岁或以上且至少有 1 年随访入组的患者。排除了基线时患有 1 型糖尿病、肾病或其他相关疾病的患者。我们使用血清肌酐和估算肾小球滤过率（eGFR）测量以及尿白蛋白与肌酐比值（UACR）的实验室订单来估计筛查率。慢性肾脏病严重程度根据实验室结果报告使用肾脏病：改善全球结果分类。
共有 1,881,447 名患有 T2D 的患者符合分析条件。平均±标准差年龄为 63.1±13.1 岁；947,150 名患者（50.3%）为男性。在 622,915 名新诊断为 T2D 的患者中，有 290,722 名患者（46.7%）在索引日期后 14 天内进行了血清肌酐检查。总体而言，在 1 年的随访期间，有 1,595,964 名患者（84.8%）至少进行了一次血清肌酐检查。在随访期间，进行 UACR 检查的患者较少（814,897[43.3%]）。不到所有 T2D 患者在随访期间接受了血清肌酐和尿白蛋白测量的实验室检查。
治疗糖尿病患者的医生选择性地遵守慢性肾脏病筛查指南，这表明 eGFR 检测率较高，但 UACR 检测率较低。尽管建议监测 eGFR 和 UACR，但在 1 年的随访期间，不到一半的患者接受了白蛋白尿筛查。
