title: Systematic kidney disease management in a population with diabetes mellitus: turning the tide of kidney failure.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Systematic disease management of patients with diabetes and kidney disease.
  
  
  METHODS
  Diverse population (approximately 800,000) in and around Birmingham, West Midlands, UK.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Renal Medicine, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK. hughrayner@nhs.net
authors: Hugh C
authors: HC
authors: Rayner
authors: Lee
authors: L
authors: Hollingworth
authors: Robert
authors: R
authors: Higgins
authors: Simon
authors: S
authors: Dodds
mesh_terms: D000367:Age Factors; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000503:physiopathology / Q000517:prevention & control*; D019468:Disease Management; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D051437:Renal Insufficiency / Q000503:physiopathology / Q000517:prevention & control*