Abstract
BackgroundsCurrent guidelines recommend routine nephropathy monitoring, including microalbuminuria or proteinuria testing, for people with diabetes mellitus; however, its effect in terms of preserving renal function remains unclear. We conducted this study to examine the impact of routine nephropathy monitoring on subsequent changes in estimated glomerular filtration rate.MethodsWe retrospectively identified non-elderly individuals with diabetes mellitus based on the prescription of hypoglycemic agents from a large Japanese database (JMDC, Tokyo, Japan) of screening for lifestyle diseases linked with administrative claims data. We collected data on baseline characteristics including age, sex, comorbidity, and laboratory data. We then examined the association between routine nephropathy monitoring results and change in estimated glomerular filtration rate using a propensity-score inverse probability of treatment weighting method.ResultsAmong 1,602 individuals who started taking hypoglycemic agents between 2005 and 2016, 102 (6.0%) underwent routine nephropathy monitoring during the first year of medication for diabetes mellitus. After adjusting for multiple confounding factors, there was no significant difference in subsequent estimated glomerular filtration rate changes between individuals with and without routine nephropathy monitoring (difference in percent change 0.11; 95% confidence interval −2.74 to 2.95).ConclusionRoutine nephropathy monitoring was not associated with preserved renal function. Current recommendations for the universal application of nephropathy monitoring may have limited value to prevent renal dysfunction in non-elderly individuals with diabetes mellitus.
Highlights
Diabetic nephropathy is the most common cause of end-stage renal disease requiring dialysis or kidney transplantation.[1,2] The number of people requiring dialysis worldwide is increasing rapidly by approximately 7% annually.[3]
The importance of this early detection of diabetic nephropathy has led to guidelines recommending routine nephropathy monitoring for all individuals with diabetes.[8,9]
Some previous studies indicated that good diabetes care, including routine nephropathy monitoring, did not necessarily improve health outcomes,[15,16] while other studies found that adherence to these care processes improved health outcomes, manifested by fewer hospitalizations and diabetes complications.[17,18]
Summary
Diabetic nephropathy is the most common cause of end-stage renal disease requiring dialysis or kidney transplantation.[1,2] The number of people requiring dialysis worldwide is increasing rapidly by approximately 7% annually.[3] Preserving renal function is, recognized as key to reducing the economic and clinical burdens of diabetes mellitus.[2]. Some previous studies indicated that good diabetes care, including routine nephropathy monitoring, did not necessarily improve health outcomes,[15,16] while other studies found that adherence to these care processes improved health outcomes, manifested by fewer hospitalizations and diabetes complications.[17,18] no study to date has directly assessed the association between routine nephropathy monitoring and subsequent renal function in individuals with diabetes mellitus
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