Almalki Abdullah H, Sadagah Laila F, Makeen Ahmad, Balla Mohamed E, Alzahrani Meshari, Kouther Faisal, Aljuffri Ahmed, Marwan Ashraf, Kotbi Eman, Dahlan Sarah, Banamah Turki, Awais Muhammed, Alharthi Majed
Department of Medicine, Nephrology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, SAU.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Cureus. 2024 Sep 3;16(9):e68584. doi: 10.7759/cureus.68584. eCollection 2024 Sep.
Background and objectives Diabetes is a leading cause of kidney failure in various regions worldwide. To detect renal disease in individuals with diabetes, screening typically involves evaluating the glomerular filtration rate and measuring albuminuria. Although there are established guidelines for these screenings, adherence to them varies. This study aims to examine the prevalence of albuminuria screening among adults with diabetes mellitus (DM) and to assess the different practices in managing these patients across primary and tertiary care settings. Methods This cross-sectional observational study involved adult patients with DM attending outpatient clinics in both primary and tertiary care settings. Patient data were gathered using a standardized form, excluding those with established chronic kidney disease (CKD) who were under nephrology care. Results The study included 1,010 patients, with 303 (30%) from primary care clinics and 707 (70%) from tertiary care clinics. The cohort comprised 582 (58%) females, with a median age of 62 years (IQR: 55-70), and approximately 990 (98%) had type 2 DM (T2DM). Annual albumin-to-creatinine ratio (ACR) screening was conducted for 498 out of 1,010 patients (49%) (95% confidence interval {CI}: 46%-52%). Screening compliance was notably higher in primary care settings compared to tertiary care clinics. Older patients (over 60 years) and those with hypertension or cardiac conditions were less likely to undergo screening. Among those screened, 185 of 498 patients (37%) (95% CI: 33%-41%) had abnormal albuminuria (ACR > 3). Conclusion Albuminuria is a significant indicator of progressing renal disease and cardiovascular risk. The annual screening rate for albuminuria in diabetic patients is inadequate. Primary care physicians show better adherence to screening guidelines compared to their tertiary care counterparts. Increasing physician awareness about the importance of screening could improve guideline compliance and mitigate the adverse effects of albuminuria.
背景与目的 糖尿病是全球各地区肾衰竭的主要病因。为了检测糖尿病患者的肾脏疾病，筛查通常包括评估肾小球滤过率和测量蛋白尿。尽管针对这些筛查有既定的指南，但对其的遵循情况各不相同。本研究旨在调查糖尿病（DM）成年患者中蛋白尿筛查的患病率，并评估在初级和三级医疗环境中管理这些患者的不同做法。方法 这项横断面观察性研究纳入了在初级和三级医疗环境的门诊就诊的成年DM患者。使用标准化表格收集患者数据，排除那些已确诊为慢性肾脏病（CKD）且正在接受肾脏病专科护理的患者。结果 该研究共纳入1010例患者，其中303例（30%）来自初级保健诊所，707例（70%）来自三级保健诊所。队列中有582例（58%）女性，中位年龄为62岁（四分位间距：55 - 70岁），约990例（98%）患有2型糖尿病（T2DM）。1010例患者中有498例（49%）（95%置信区间{CI}：46% - 52%）进行了年度白蛋白与肌酐比值（ACR）筛查。与三级保健诊所相比，初级保健环境中的筛查依从性明显更高。老年患者（60岁以上）以及患有高血压或心脏病的患者接受筛查的可能性较小。在接受筛查的患者中，498例患者中有185例（37%）（95% CI：33% - 41%）蛋白尿异常（ACR > 3）。结论 蛋白尿是肾脏疾病进展和心血管风险的重要指标。糖尿病患者的年度蛋白尿筛查率不足。与三级保健医生相比，初级保健医生对筛查指南的遵循情况更好。提高医生对筛查重要性的认识可以改善指南依从性并减轻蛋白尿的不良影响。
