Effect Of Regular Visits On Urinary Albumin Excretion Rate And Glomerular Filtration Rate In Patients With Type 2 Diabetic Kidney Disease

Objection:To investigate the effect of regular visits on urinary albumin excretion rate(UAER)and glomerular filtration rate(GFR)in patients with type 2 diabetic kidney disease.Materials and Methods:We collected 181 patients with type 2 diabetic kidney disease in the Department of endocrinology of Jinan Central Hospital from September 2017 to December 2018.We collected general information of age,sex,course of diabetes mellitus,course of DKD,body mass index(BMI),smoking history,history of hypertension,history of hyperuricemia,history of hyperlipidemia and family history of DKD.Laboratory indexes of UAER,GFR,FPG,SBP,DBP,TC,TG,HDL-c,LDL-c,HbA1c and examination of ocular fundus were collected during each visit in the past four years.Self-management Behavior Scale of Diabetes Mellitus(SDSCA)was used to investigate the recent self-management level of patients.According to the outpatient visits in the past four years,79 cases were divided into regular visits group and 102 cases into irregular visits group(regular visits were less than or equal to three months each time,and persisted for more than one year),The general data,laboratory indicators,SDSCA scores,UAER,GFR reversal rate and progress rate of the first and last visits were compared between the two groups.According to the changing trend of UAER,52 cases were divided into UAER progressive group and 129 cases into UAER non-progressive group.According to the changing trend of GFR,54 cases were divided into GFR progressive group and 127 cases were divided into GFR non-progressive group.The risk factors of UAER and GFR progress were screened by single factor analysis,and the independent risk factors of UAER and GFR progress were analyzed by logistic regression model.Results:1.Comparisons of data of first and last visits between regular and irregular visitsThere was no significant difference in general information,FPG,SBP,DBP,LDL-c,HDL-c and DR ratio between the two groups,and there was good comparability.Compared with the indexes of the last visit,the FPG,HbA1c,SBP,DBP,LDL-c,HDL-c and TG of the regular group were higher than those of the irregular group.There were statistical differences in FPG(χ2=6.394,P=0.011),HbAlc(χ2=10.607,P=0.001)and LDL-c(χ2=8.486,P=0.004).The control of blood sugar,blood pressure and blood lipid in regular group was better than that in irregular group.Compared with the recent self-management level of the two groups,the SDSCA score of the regular group was higher(χ2=4.171,P<0.001),and the percentage of good level and medium level in the group was higher than that of the irregular group(χ2=11.797,P=0.003)· There was statistical difference between the two groups,and the self-management level of the regular group was higher than that of the irregular group.2.Comparison of UAER and GFR changes between regular and irregular visiting groupsThe reverse rate of UAER in regular group was 43%,the progress rate was 15.2%,the reverse rate of irregular group was 13.8%,and the progress rate was 39.2%.The reverse rate of UAER in regular group was higher than that in irregular group,and the progress rate was lower than that in irregular group(χ2=26.587,P<0.001),there were statistical differences.The Non-Progress rate of GFR in regular group was 82.3%,the progress rate was 17.7%,the Non-Progress rate of GFR in irregular group was 60.8%,and the progress rate was 39.2%.The Non-Progress rate in regular group was higher than that in irregular group,and the progress rate was lower than that in irregular group group(χ2=9.825,P=0.002),there were statistical differences.3.Risk factors affecting the progress of UAER and GFRThe indexes of UAER progressive group and non-progressive group were analyzed by t-test and χ2-test.The percentage of regular visits(χ2=12.551,P<0.001),SBP(χ2=12.089,P=0.001),FPG(χ2=6.441,P=0.011)and SDSCA scores(χ2=4.702,P<0.001)of progressive group were lower than those of non-progressive group,and there were statistical differences.Logistic regression analysis showed that SDSCA scores of more than 80%(OR=0.097)were helpful to delay the progress of UAER.Irregular visits(OR=2.625)and SBP failure((OR=5.451)were independent risk factors for UAER progress.Indicators of GFR progressive group and non-progressive group were analyzed by t-test and χ2-test.The proportion of SBP(χ-2=10.596,P=0.001)and regular visits(χ2=9.825,P=0.002)in progressive group was lower than that in non-progressive group,and the proportion of retinopathy(χ2=5.711,P=0.0.017)combined was higher than that in non-progressive group and there were statistical differences.Logistic regression analysis showed that irregular visits(OR=2.916),combined retinopathy(OR=2.387),and SBP failure(OR=4.213)were independent risk factors for the progression of GFR.Conclusions:1.Regular visits is helpful to the improvement of blood sugar,blood pressure,blood lipid and self-management level2.Regular visits contributed to reverse of UAER and Non-Progress of GFR,and delay the progress of UAER and GFR.3.The protective factors of UAER progress were high self-management level,the independent risk factors of UAER progress were irregular visits and SBP failure;the independent risk factors of GFR progress were irregular visits,retinopathy and SBP failure.