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Systematic kidney disease management in a population with diabetes mellitus: turning the tide of kidney failure.

Rayner, Hugh C and Hollingworth, Lee and Higgins, Robert and Dodds, Simon (2011) Systematic kidney disease management in a population with diabetes mellitus: turning the tide of kidney failure. BMJ quality & safety, 20 (10). pp. 903-10. ISSN 2044-5423. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://qualitysafety.bmj.com/content/20/10/903.lon...

Abstract

PROBLEM

A significant proportion of patients with diabetes mellitus do not get the benefit of treatment that would reduce their risk of progressive kidney disease and reach a nephrologist once significant loss of kidney function has already occurred.

DESIGN

Systematic disease management of patients with diabetes and kidney disease.

SETTING

Diverse population (approximately 800,000) in and around Birmingham, West Midlands, UK.

KEY MEASURES FOR IMPROVEMENT

Number of outpatient appointments, estimated glomerular filtration rate (eGFR) at first contact with nephrologist, number of patients starting kidney replacement therapy (KRT) and mode of KRT at start.

STRATEGY FOR CHANGE

Identification of patients with low or deteriorating trend in eGFR from weekly database review, specialist diabetes-kidney clinic, self-management of blood pressure and transfer to multidisciplinary clinic >12 months before end-stage kidney disease.

EFFECTS OF CHANGE

New patients increased from 62 in 2003 to 132 in 2010; follow-ups fell from 251 to 174. Median eGFR at first clinic visit increased from 28.8 ml/min/1.73 m(2) (range 6.1-67.0) in 2000/2001 to 35.0 (11.1-147.5) in 2010 (p<0.006). In 2010, the number of patients starting KRT fell 30% below the projected activity using 1993-2003 data as baseline (p<0.003). The proportion starting KRT with either a kidney transplant, peritoneal dialysis or haemodialysis via an arteriovenous fistula increased from 26% in 2000 to 55% in 2010.

LESSONS LEARNED

Systematic disease management across a large population significantly improves patient outcomes, increases the productivity of a specialist service and could reduce healthcare costs compared with the current model of care.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WJ Urogenital system. Urology
WK Endocrine system. Endocrinology
Divisions: Emergency Services > Renal
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 02 Dec 2014 11:11
Last Modified: 02 Dec 2014 11:11
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/708

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