IS THERE VALUE TO A COMBINED DIABETES-RENAL CLINIC IN DIABETES KIDNEY DISEASE?

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 807-838-Diabetes - Diagnosis, Complications & Outcomes
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-834
Luisa Alejandra Duran*1, Raimund Pichler1, Irl B Hirsch2 and Dace Lilliana Trence1
1University of Washington, Seattle, WA, 2Univ of Washington Med Ctr, Seattle, WA
The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines strongly recommend referral to a nephrologist for patients with GFR<30mL/min/1.73 m2 (CKD4-5), but only suggest referral for GFR 30 to <60 mL/min/1.73 m2. Patients with diabetes present a high risk population for kidney disease that may benefit from earlier nephrologist intervention. We present the initial results from a combined diabetes-renal clinic established at an academic medical center for patients with diabetes and non-end-stage renal disease using predetermined guidelines of  GFR>40mL/min and/or proteinuria defined as  >500mg/24hours. 88 patients were seen between 2006-2012. The majority had either type 1 DM (51.1%, n=45) or type 2 DM (44.3%, n=39), remainder noted as pancreatic diabetes, latent autoimmune diabetes of the adult (LADA), or unknown.  At initial visit, mean baseline estimated GFR was 46.2mL/min (range 19-60mL/min) and 72.7% (n=64) had a urine albumin/Cr >30mg/dl. Mean age was 56 years (range 18-85 years).  Majority were men (62.5%, n=55) of non-hispanic white race (73.8%, n=65).  Mean duration of type 1 DM was 28.6 years, for type 2 DM 17.7 years. Overall mean HbA1c was 7.6% (range 5.5-14.9%). 89.7% (n=79) were on insulin therapy. Diabetic retinopathy was absent in 9 out of 38 type 1 DM patients with documented retinal exams, 19 out of 41 with type 2 DM. Nearly all patients had a history of HTN (95.4%, n=84) of which 37.5% had SBP>130 at initial referral. Diagnostic tools used in kidney disease evaluation included: renal ultrasound (63 patients), renal artery duplex ultrasound (37), and kidney biopsy (13). Work-up resulted in detection of 7 cases of non-diabetic or non-classic DM renal disease, of which IgA nephropathy was most frequent (n=2), followed by arterionephrosclerosis (n=1), obstructive nephropathy (n=1) and acute interstitial nephritis superimposed with diabetic nephropathy (n=1). Two cases of maternally inherited diabetes and deafness (MIDD) were suspected, although these patients declined definitive diagnosis by genetic analyses or renal biopsy. In conclusion, early nephrologist involvement for patients with diabetes and renal disease can diagnose unsuspected etiologies to renal disease. Referral outside of the KDOQI guidelines deserves further investigation. Outcomes data for earlier nephrologist involvement in a combined Diabetes-Renal Clinic are currently being analyzed.

Nothing to Disclose: LAD, RP, IBH, DLT

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