Assessment of level of care of diabetic patients with nephropathy in predialysis stage 4 in Tanta

Abstract

Background Stage 4 chronic kidney disease (CKD) in comparison with earlier stages of CKD is associated with higher morbidity, mortality, and costs, and current guidelines recommend greater intensity of care for patients with stage 4 disease. Aim Our study assessed the level of care of patients with diabetic nephropathy (DN) in predialysis stage (CKD stage 4) in Tanta. Patients and methods A total of 257 patients experiencing DN stage 4 from Tanta were subjected to a questionnaire sheet that included age; duration of diabetes; time of diagnosis of DN; treatment of hypertension; patient diet; antidiabetic drugs; level of serum creatinine; estimated glomerular filtration rate; hemoglobin level; serum levels of Ca, Ph, parathyroid hormone, Na, K, and HCO3; lipid profile; statin therapy; and hemoglobin A1c. The data collected were compared with Kidney Disease: Improving Global Outcomes clinical practice guideline for the evaluation and management of CKD. Results Of the 257 patients, 27.6% were type 1 diabetics and 72.4% were type 2. The mean duration of diabetes was 12.43 years (±6.388). Overall, 29.9% had uncontrolled elevated blood pressure, of whom 27.2% were on no antihypertensive drugs. Renin-angiotensin-aldosterone system blockage agents were used in 52.1% of patients. Overall, 57.2% had good control of diabetes. Dyslipidemia was found in 49.4% patients of them 62.2% patients were on no statin therapy. Hypocalcemia was found in 5.4% patients, hyperphosphatemia was found in 12.4% patients, 4.7% had secondary hyperparathyroidism, 79.8% had bicarbonate level below normal range, 9.7% had mild elevate potassium level, and 20.4% had anemia. Conclusion Our patients reached stage 4 early after few years of diabetes, and parameters that need more level of care include hypertension, diabetes, treatment used for diabetes, dyslipidemia, and acidosis.