OP48 The management of patients with diabetic kidney disease prior to specialized nephrology care. A 24 months review at the Yaounde General Hospital

Introduction: Several therapeutic strategies to slow the progression of kidney damage and reduce cardiovascular mortality exist for patients with diabetic kidney disease. However, the degree of implementation of these preventive strategies is unknown in Cameroon. We therefore sought to evaluate the care of type 2 diabetics with chronic kidney disease (CKD) prior to specialist nephrology care at the Yaounde General Hospital. Methods: Records of all incident type 2 diabetics with CKD seen in the nephrology unit from January 2009 to December 2010 were studied. All data was prospectively collected during the period under study. Relevant clinical and laboratory data obtained on the first nephrology visit was sought. GFR was estimated using the MDRD (4 variables) equation. Proteinuria evaluated by dipsticks. Data was analyzed with the aid of SPSSv10 software using usual statistical methods. Continuous data is expressed as Mean ± SD. Ethical clearance for the study was obtained from the hospital ethics board. Results: A total of 87 (65 M, 22 F) participants were included, 33% referred by endocrinologists, and 25.6% by cardiologists. Age = 62.05±8 yrs., diabetes vintage = 13.39±7.62 yrs, BMI = 26.45±3.98 kg/m2 (18.8% obese). The eGFR was 23.09±20.38 ml/min. (70.1% in CKD stage 4 and 5). Hypertension was present in 98.6% of participants. Seventy-two patients were receiving anti-diabetic drugs (34 insulin; 38 oral agents). HbA1C = 7.25±1.87%, SBP = 150.36±22.19 mmHg and DBP = 86.16±13.94 mmHg, proteinuria = 291±0.69 mg/dl (>2+ in 75%). Only 50% were on RAS blockers and 42% on statins. Optimal Blood pressure control = 4.6%, LDL cholesterol <1 g/dl = 48.3%, and HbA1C <7% = 34% of participants. Conclusion: Preventive strategies for kidney and cardiovascular disease in diabetic patients are underutilized by nonnephrologists in our setting; with patients referred late for nephrology care. These results highlight the need for a comprehensive educational program for healthcare givers involved in the care of diabetics.