[Hospital-primary care teamwork in nephrology: 'preventive' epidemiology of diabetic nephropathy].
BACKGROUND
The onset of clinical proteinuria in patients with diabetic nephropathy usually marks the existence of irreversible and progressive kidney damage. Prevention of chronic renal failure ought to take place in earlier stages, mostly in the outpatient setting and in close collaboration with general practitioners (GPs). This study aims to evaluate the prevalence and the clinical stage of diabetic nephropathy and to screen for progression factors in the regional community referred to the outpatient department of the nephrology unit of the Mons. DiMiccoli Hospital in Barletta; it is intended as the first phase of a collaborative project for the prevention of diabetic nephropathy.


METHODS
Our team asked for the collaboration of GPs within the geographic area referring to our outpatient department. This led to the institution of a working group aimed at interrelating primary with hospital care in the setting of nephrology. The clinical data of diabetic patients as well as their codified personal data were classified by GPs and subsequently processed by the nephrology team. The glomerular filtration rate was estimated by means of the abbreviated MDRD study equation. Finally, the cumulative prevalence of known risk factors for diabetic nephropathy progression was assessed in a subgroup of 201 diabetic patients.


RESULTS
Within the whole group of screened subjects from the regional community (21,314), the prevalence of diabetes was 3.54%, and the rates of personal and clinical features did not show any substantial differences from the ones recorded in Italy as a whole. In the subgroup of 201 diabetic patients, the cumulative frequency of progression factors for diabetic nephropathy showed a relevant percentage of subjects with clinical and laboratory features deviating from the targets proposed by current guidelines, thus justifying the adoption of specific prevention plans.


CONCLUSIONS
This study shows the feasibility and the advantages of setting up a stable collaboration between hospital and primary care in order to improve the diagnosis and prevention of kidney disease. Identification of the most frequently deviant progression factors provides the primary target for the prevention of kidney damage in diabetic patients.
Russo
D
D
Struttura Complessa di Nefrologia e Dialisi, Ospedale Mons R Di Miccoli, AUSL BAT/1, Barletta (BA), Italy. russodm@cheapnet.it
Vico
A
A
Monterisi
F
F
Biga
M L
ML
Falanga
R
R
Mancini
A
A
Teutonico
A
A
Losappio
R
R
Gruppo di Integrazione Territtorio-Ospedale In Nefrologia
G I T O N
GI
D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006786:Hospitals, Urban; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care; D018570:Risk Assessment; D012307:Risk Factors