Identification of factors associated with and preventative strategies in diabetic nephropathy
AbstractThe aim of this research was to identify factors associated with and assess the efficacy of preventative strategies in the treatment of diabetic nephropathy from data collected at nephrological out-patient follow-up visits. A study of mortality, over a ten year period, in 1,421 diabetic and 26,990 non-diabetic people in Wolverhampton identified cardiovascular disease as the predominant cause of death in both groups, with female diabetic patients having an increased risk of dying from cardiovascular disease in comparison to male diabetic and female non-diabetic people. Diabetic nephropathy accounted for 4% of deaths in diabetic people. From 220 patients referred for nephrological assessment, diabetic nephropathy was diagnosed in 149. Comparison of nephropathy patents with control subjects, without nephropathy, and people with non-diabetic renal disease identified poor glycaemic control, hypertension, smoking history and defaulting from clinic visits as factors associated with nephropathy. The onset of nephropathy, retinopathy and hypertension, from diagnosis of diabetes, appeared to be accelerated in Type 2 patients, especially in Indo-Asian people. Assessment of the efficacy of preventative treatment strategies was made by determining survival in 141 nephropathy patients over eleven years. Sevenyear survival was better in a subgroup of patients with serum creatinine levels within normal limits at nephrological assessment in comparison to the main group. Five year survival of patents on renal replacement therapy was better than observed in other studies. Un6ontrolled hypertension, which was a hazard to survival, was common, and in many patients was untreated. Initial reduction of blood pressure after nephrological referral was not sustained in the majority of patients. Black patients had the worst hypertension control. The inability to speak English contributed to defaulting from routine clinic visits, was a risk for developing nephropathy and was a specific hazard for survival in Indo-Asian patents, especially in men, as was current cigarette smoking in Black patients.
PublisherUniversity of Wolverhampton
TypeThesis or dissertation
DescriptionA thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy
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