Abstract
The aim of this study was to assess the prevalence of chronic kidney disease (CKD) among type 2 diabetic patients in primary care settings in Switzerland, and to analyse the prescription of antidiabetic drugs in CKD according to the prevailing recommendations. In this cross-sectional study, each participating physician was asked to introduce anonymously in a web database the data from up to 15 consecutive diabetic patients attending her/his office between December 2013 and June 2014. Demographic, clinical and biochemical data were analysed. CKD was classified with the KDIGO nomenclature based on estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio. A total of 1 359 patients (mean age 66.5 ± 12.4 years) were included by 109 primary care physicians. CKD stages 3a, 3b and 4 were present in 13.9%, 6.1%, and 2.4% of patients, respectively. Only 30.6% of patients had an entry for urinary albumin/creatinine ratio. Among them, 35.6% were in CKD stage A2, and 4.1% in stage A3. Despite prevailing limitations, metformin and sulfonylureas were prescribed in 53.9% and 16.5%, respectively, of patients with advanced CKD (eGFR <30 ml/min). More than a third of patients were on a dipeptidyl-peptidase-4 inhibitor across all CKD stages. Insulin use increased progressively from 26.8% in CKD stage 1-2 to 50% in stage 4. CKD is frequent in patients with type 2 diabetes attending Swiss primary care practices, with CKD stage 3 and 4 affecting 22.4% of cases. This emphasizes the importance of routine screening of diabetic nephropathy based on both eGFR and urinary albumin/creatinine ratio, the latter being largely underused by primary care physicians. A careful individual drug risk/benefit balance assessment is mandatory to avoid the frequently observed inappropriate prescription of antidiabetic drugs in CKD patients.
Highlights
Chronic kidney disease (CKD) in diabetic patients is on the rise owing to the increased prevalence of type 2 diabetes (T2D) and the aging population [1]
chronic kidney disease (CKD) is frequent in patients with type 2 diabetes attending Swiss primary care practices, with CKD stage 3 and 4 affecting 22.4% of cases
This emphasizes the Abbreviations ACR albumin/creatinine ratio CKD chronic kidney disease CKD-EPI Chronic Kidney Disease-Epidemiology Collaboration DPP-4 dipeptidyl-peptidase-4 eGFR estimated glomerular filtration rate GLP-1 glucagon-like peptide-1 KDIGO Kidney Disease: Improving Global Outcomes T2D type 2 diabetes importance of routine screening of diabetic nephropathy based on both eGFR and urinary albumin/creatinine ratio, the latter being largely underused by primary care physicians
Summary
Chronic kidney disease (CKD) in diabetic patients is on the rise owing to the increased prevalence of type 2 diabetes (T2D) and the aging population [1]. We are lacking data for the prevalence of CKD in the diabetic population followed-up by primary care physicians in Switzerland it is well recognised that in the last decades diabetic nephropathy has become one of the leading causes of end-stage renal disease. In Switzerland, recommendations for the use of antidiabetic drugs in CKD were elaborated in 2012 by the Swiss Society of Endocrinology and Diabetology (SSED) [2]. Whether these recommendations have reached PCPs and are followed by them is not clear and has never been evaluated. The goal of this cross-sectional study was to examine the prevalence of CKD stages in T2D patients followed-up by PCPs in Switzerland and to examine the prescription of antidiabetic drugs
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