Treatment Choices in Type 2 Diabetes in patients with Chronic Kidney
Disease in West Glamorgan
Patients with chronic kidney disease (CKD ≥3) and diabetes mellitus comprise approximately 25% patients with diabetes. These patients are at a higher risk of cardiovascular morbidity and mortality than the general population and furthermore therapies targeting glucose control are limited. The management of glycaemic control in type 2 diabetes and chronic renal disease is difficult with limited therapeutic choices. This issue has been a matter of longstanding debate.
Following a number of joint Diabetes-Renal meetings between the Diabetes and Renal teams based in Hywel Dda and ABM University Health Boards, a proposal was put forward to the SAIL team to examine the relationship between diabetes therapies in relation to eGFR, as this may influence further practice and guidance for patients with type 2 diabetes and renal impairment.
Acute Kidney Injury: Alerts and Outcomes in Wales
Acute Kidney Injury (AKI) is a serious condition leading to or complicating around 20% of hospital admissions. It is associated with an increased risk of death and illness. The serum creatinine level is measured from a blood test which enables diagnosis and management of AKI. It is thought that informing the clinician who is managing the patient’s condition to changes in their serum creatinine levels with an alert, may enable the clinician to make changes to patient management. This may in turn improve patient outcomes.
Hospital episodes should be coded for significant diagnoses. Accurate coding is important to monitor trends,assess complication rates and though outside of the scope of this study - are used to enable comparisons of hospital performance. This is done by using measures such as the RAMI (Risk adjusted Mortality Index) score. Validation of the reliability of coding for AKI will help justify whether studies or scores can rely on coding statistics as a measure of performance.
An AKI alert (also referred to as e-alert) system has been used in Wales since 2014. The alert system is currently active in secondary (specialist) care and this study is designed to assess if alerts have been generated appropriately and whether the outcomes of patients who develop AKI have changed as a result of the introduction of the AKI alerts.
Aims and Objectives
To validate that the AKI Alert system in Wales triggers appropriate alerts in secondary care.
To describe the outcomes of AKI before and after the introduction of AKI alerts – including length and type of stay, dialysis and risk of death.
To describe the coding of the hospital episode statistics for patients who experience AKI.
To produce a highly phenotyped cohort of patients who experience AKI for further study
Dr Tim Scale is working on this arm of the research.