Identification, investigation and management of patients with diabetic nepropathy at the primary and secondary care interface.

Doctoral thesis English OPEN
Craig, Kathrine Jane
  • Subject: RC | RA

Approximately 170 million individuals worldwide have been diagnosed with Diabetes Mellitus and between 85--90% of the total population have Type 2 Diabetes Mellitus. Health care is facing an epidemic not only of Diabetes Mellitus but also of the consequence of the attendant morbidity including macro and micro diseases of the vascular system. Of particular interest for the purposes of this thesis, is the progression to nephropathy and development of cardiovascular risk of a proportion of this population and the investigation of strategies that may slow the decline to end stage renal failure and the need for renal replacement therapy or premature death due to cardiovascular disease. Initially, screening practice for microalbuminuria was altered, with patients being identified during their clinic visit, rather than retrospectively. In addition, data on blood pressure levels and antihypertensive agents prescription was collected and collated. Subsequently, a nurse specialist optimised the risk factor management of a cohort of patients with Diabetic Nephropathy using an algorithm driven evidenced based approach. Finally, analysis was undertaken of the factors that might contribute to the development of anaemia in diabetic nephropathy and hence to increased cardiovascular risk. The work described in this thesis demonstrates the inherent complexities of dealing with a problem that involves the maintenance of health within a system that has been set up primarily to deal with the consequences of illness.
  • References (24)
    24 references, page 1 of 3

    [14] Miettinen H, Lehto SS, Mahonen M, Niemela M, Haffner SM, Pyorala K, et al. Impact of diabetes on mortality after the first myocardial infarction. Diabetes Care. 1998;21:69-75.

    [15] Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kidney Dis. 1996;27(2): 167-94.

    [16] Ritz E, Orth SR. Nephropathy in patients with type 2 diabetes mellitus. N Engl J Med. 1999;341(15):1127-33.

    [17] Bojestig M, Arnqvist HJ, Hermansson G, Karlberg BE, Ludvigsson J. Declining incidence of nephropathy in insulin-dependent diabetes mellitus. N Engl J Med. 1994;330(1):15-8.

    [18] Hasslacher C, Ritz E, Wahl P, Michael C. Similar risks of nephropathy in patients with Type I or Type II diabetes mellitus. Nephrology Dialysis Transplantation. 1989;4:859-63.

    [19] US Renal Data System. USRDS 1998 annual report. Bethesda,MD: The National Institutes of Health; 1998.

    [20] Ansell D, Feest T, Tomson C, Williams AJ, Warwick G, et al. UK Renal Registry Report. Bristol, UK: UK Renal Registry;; 2006.

    [21] UK prospective diabetes study group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. British Medical Journal. 1998;327:703-13. [28] Wolf G, Ziyadeh FN. Molecular mechanisms of diabetic renal hypertrophy. Kidney International. 1999;56:393.

    [39] Poirier P, Giles T, Bray G, Hong Y, Stern J, Pi-Sunyer F, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Arteriosclerosis, Thrombosis & Vascular Biology. 2006;26(5):968-76.

    [40] Ejerblad E, Fored CM, Lindblad P. Obesity and risk for chronic renal failure. Journal of the American Medical Association. 2006;17:1695.

  • Metrics
    views in OpenAIRE
    views in local repository
    downloads in local repository

    The information is available from the following content providers:

    From Number Of Views Number Of Downloads
    Online Research @ Cardiff - IRUS-UK 0 17
Share - Bookmark