Referral to nephrologists is associated with the slow progression of kidney dysfunction in patients with type 2 diabetes mellitus.

IF 3.8 3区医学 Q1 UROLOGY & NEPHROLOGY Kidney Research and Clinical Practice Pub Date : 2025-03-19 DOI:10.23876/j.krcp.24.217

Donghwan Yun, Sohyun Bae, Sehoon Park, Yong Chul Kim, Dong Ki Kim, Kook-Hwan Oh, Kwon Wook Joo, Yon Su Kim, Seung Seok Han

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Abstract

Background: Although treatment guidelines exist, referrals and discussions among clinicians about the disease can lead to more appropriate treatment for the patient. This study evaluated the effects of referrals from diabetes clinics to nephrologists on kidney function in type 2 diabetic patients through causal inference analysis.

Methods: This study included patients with type 2 diabetes who initially visited the diabetes clinic between 2004 and 2023. Patients were either referred to nephrologists (named the referral group) or continued under the care of diabetologists in the diabetes clinic (named the non-referral group). The slope of the estimated glomerular filtration rate (eGFR) per year was calculated based on the annual median difference in yearly eGFRs, and cases were censored when the values dropped below 10 mL/min/1.73 m2. We applied a difference-in-differences model to this time-series dataset with an inverse propensity weighting estimator to evaluate the effect of referral to nephrologists.

Results: Among the 30,160 patients who initially visited the diabetes clinic, 3,885 (12.9%) were referred to nephrologists during follow-up. At the time of referral, the median (interquartile range) values of the eGFR and random urine albumin-to-creatinine ratio were 55.0 mL/min/1.73 m2 (40.3-76.8 mL/min/1.73 m2) and 107 mg/g (20-846 mg/g), respectively. The average treatment effect of referral to nephrologists was an improvement in the eGFR slope, with an increase of 5.8 mL/min/1.73 m2 (95% confidence interval, 4.8-6.8 mL/min/1.73 m2) per year. The effect of referral was greater in patients with a high risk of progression than in those with a low risk.

Conclusion: Referral to nephrologists is associated with slow progression of kidney dysfunction in patients with type 2 diabetes, supporting the need to evaluate how to facilitate timely referral for each patient as a next step.

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2型糖尿病患者转诊到肾病科与肾功能障碍进展缓慢有关。

背景：虽然存在治疗指南，但临床医生之间关于该疾病的转诊和讨论可以为患者提供更合适的治疗。本研究通过因果推理分析，评估从糖尿病诊所转诊到肾脏科医师对2型糖尿病患者肾功能的影响。方法：本研究纳入了2004年至2023年间首次就诊的2型糖尿病患者。患者被转介给肾病专家（称为转诊组）或继续在糖尿病诊所接受糖尿病专家的治疗（称为非转诊组）。估计每年肾小球滤过率（eGFR）的斜率是根据每年eGFR的年中位数差来计算的，当数值低于10 mL/min/1.73 m2时，病例被删除。我们对这个时间序列数据集应用了差异中的差异模型，并使用逆倾向加权估计器来评估转诊给肾病学家的效果。结果：在最初就诊的30160例糖尿病患者中，3885例（12.9%）在随访期间转诊给肾病专家。在转诊时，eGFR和随机尿白蛋白与肌酐比值的中位数（四分位数范围）分别为55.0 mL/min/1.73 m2 （40.3-76.8 mL/min/1.73 m2）和107 mg/g （20-846 mg/g）。转诊肾病专家的平均治疗效果是eGFR斜率的改善，每年增加5.8 mL/min/1.73 m2（95%可信区间，4.8-6.8 mL/min/1.73 m2）。转诊对进展风险高的患者的影响大于低风险的患者。结论：2型糖尿病患者转诊到肾病科与肾功能障碍进展缓慢相关，因此下一步需要评估如何促进每位患者的及时转诊。

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来源期刊

Kidney Research and Clinical Practice UROLOGY & NEPHROLOGY-

CiteScore

4.60

自引率

10.00%

发文量

审稿时长

10 weeks

期刊介绍： Kidney Research and Clinical Practice (formerly The Korean Journal of Nephrology; ISSN 1975-9460, launched in 1982), the official journal of the Korean Society of Nephrology, is an international, peer-reviewed journal published in English. Its ISO abbreviation is Kidney Res Clin Pract. To provide an efficient venue for dissemination of knowledge and discussion of topics related to basic renal science and clinical practice, the journal offers open access (free submission and free access) and considers articles on all aspects of clinical nephrology and hypertension as well as related molecular genetics, anatomy, pathology, physiology, pharmacology, and immunology. In particular, the journal focuses on translational renal research that helps bridging laboratory discovery with the diagnosis and treatment of human kidney disease. Topics covered include basic science with possible clinical applicability and papers on the pathophysiological basis of disease processes of the kidney. Original researches from areas of intervention nephrology or dialysis access are also welcomed. Major article types considered for publication include original research and reviews on current topics of interest. Accepted manuscripts are granted free online open-access immediately after publication, which permits its users to read, download, copy, distribute, print, search, or link to the full texts of its articles to facilitate access to a broad readership. Circulation number of print copies is 1,600.