대한신장학회

논문분류	춘계학술대회 초록집
제목	The Impact of the ABC Clinical Targets on Progression of Chronic Kidney Disease in Thai Patients with Type 2 Diabetes Mellitus
저자	Paithoon Sonthon1, Siribha Changsirikulchai2, Cameron Hurst-3
출판정보	2016; 2016(1):
키워드	Type2 Diabetes mellitus, T2DM, Chronic kidney disease, CKD
초록	developing and developed countries. CKD is a major problem because it is associated with a substantial burden of mortality, morbidity and health care costs. The prevalence of CKD among T2DM patients is rapidly increasing worldwide, including countries like Thailand. Improving the quality of care in T2DM patients is a strategy to attenuate the CKD problem. The present study aims to investigate the impact of achieving T2DM clinical targets on the progression of CKD in T2DM patients. Methods: This study was a retrospective cohort study from the DMHT data set which was a national survey in Thai patients with T2DM visiting in 595 hospitals across the country. Patients who were observed at least 2 times in the 3 years follow up (between2011-2013) were included in our study. Ordinal logistic mixed effect regression modeling was used to investigate the association between the quality of care and CKD progression. The targets of care was defined to achieve ABC goal in diabetes (A: HbA1C≤7%, B: BP≤130/80 mmHg, C: LDL-C<100 mg/dL). CKD diagnosis was based on albuminuria and estimated GFR (eGFR) with the categories of CKD classified based on the KDIGO 2012. The progression of CKD was defined by declining of eGFR to the next stage of CKD. Results: The data of 3,133 T2DM patients were analyzed. The prevalence of CKD was 69% (38.6% moderately increased risk, 23% high risk and 7.2% very high risk). The proportion of patients achieving target in BP, LDL-C and HbA1C were 53.49%, 53.49% and 33.93%, respectively. After adjusting for covariates, we found that the achievement of HbA1C target (≤7%) was the only target protective factor against CKD progression (ORadj= 0.76, 95%CI: 0.59 - 0.98; p<0.05). The achievement of BP and LD-C targets could not be shown to be associated with CKD progression (ORadj= 0.94, 95%CI: 0.75-1.19 and ORadj= 0.88, 95% CI: 0.65-1.19; both p>0.05, respectively). Conclusion: We showed that achievement of HbA1C≤7% was protective against progression of CKD. Therefore, we suggest that measures should be taken to help patients with T2DM and CKD, without risk of hypoglycemia, to control their HbA1c levels.
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