Long‐term outcomes of patients with type 2 diabetes attending a multidisciplinary diabetes kidney disease clinic

Background The best model of care to retard diabetic kidney disease (DKD) in the clinic is underexplored. In this study we investigated the long‐term renal outcomes of a joint endocrinologist–nephrologist clinic. Methods The present study was a nested case‐control study derived from a cohort of patients with type 2 diabetes mellitus (T2DM) seen prospectively at a secondary care diabetes center (DC). Cases (“DKD clinic group”) were patients seen at the CKD clinic after being referred by physicians in DCs for management of DKD. Controls (“non‐DKD clinic group”) were patients from the same DC (i.e. same source population) with the same inclusion criteria of Stages 3–4 chronic kidney disease (CKD) at baseline but not seen at the DKD clinic. The outcome was Stage 5 CKD, defined as an estimated glomerular filtration rate <15 mL/min per 1.73 m 2 . Results During the median follow‐up period of 3.0 years (interquartile range 1.2–5.1 years), 240 patients (28.7%) reached Stage 5 CKD, with 45.8% and 54.2% of those reaching Stage 5 CKD in the DKD and non‐DKD clinic groups, respectively. Multivariable Cox regression revealed that the DKD clinic group had a lower risk of progressing to Stage 5 CKD (hazard ratio 0.55; 95% confidence interval 0.36–0.83; P = 0.004) compared with the non‐DKD clinic group. Conclusions Multidisciplinary endocrinology and nephrology care in the DKD clinic is associated with a lower risk of end‐stage renal disease. These findings may inform future management strategies targeted at patients with T2DM and CKD, especially with regard to joint specialist management involving endocrinologists and nephrologists.