The impact of the quality of care and other factors on progression of chronic kidney disease in Thai patients with Type 2 Diabetes Mellitus: A nationwide cohort study.

The present study investigates the impact of quality of care (QoC) and other factors on chronic kidney disease (CKD) stage progression among Type 2 Diabetes Mellitus (T2DM) patients.This study employed a retrospective cohort from a nationwide Diabetes and Hypertension study involving 595 Thai hospitals. T2DM patients who were observed at least 2 times in the 3 years follow-up (between 2011-2013) were included in our study. Ordinal logistic mixed effect regression modeling was used to investigate the association between the QoC and other factors with CKD stage progression.After adjusting for covariates, we found that the achievement of the HbA1c clinical targets (≤7%) was the only QoC indicator protective against the CKD stage progression (adjusted OR = 0.76; 95%CI = 0.59-0.98; p<0.05). In terms of other covariates, age, occupation, type of health insurance, region of residence, HDL-C, triglyceride, hypertension and insulin sensitizer were also strongly associated with CKD stage progression.This cohort study demonstrates the achievement of the HbA1c clinical target (≤7%) is the only QoC indicator protective against progression of CKD stage. Neither of the other clinical targets (BP and LDL-C) nor any process of care targets could be shown to be associated with CKD stage progression. Therefore, close monitoring of blood sugar control is important to slow CKD progression, but long-term prospective cohorts are needed to gain better insights into the impact of QoC indicators on CKD progression

Study flow.

<p>Study flow.</p

CKD stage progression from the first observation to the last observation.

<p><b>(1,630 patients).</b> Shaded bars represent stable patients whereas those below the shaded bars represent improved CKD stage, and those above the bars represent patients whose CKD stage progressed.</p

Association between process of care and progression of CKD.

<p>Association between process of care and progression of CKD.</p

Association between clinical targets of care and progression of CKD.

<p>Association between clinical targets of care and progression of CKD.</p

Baseline of characteristics of patients with the two or more and with only a single observation.

<p>Baseline of characteristics of patients with the two or more and with only a single observation.</p