Clinical Characteristics of Cases that Progressed to Hemodialysis Among Participants Diabetic Nephropathy Education Programs

Abstract

We have been providing group (diabetic nephropathy class; DN class) and individual education at outpatient clinics to inhibit renal functional decline and delay the introduction of hemodialysis in patients with DN. Unfortunately, some patients who attended the class developed HD. Therefore, we aimed to clarify the characteristics of these patients in this study. We included 96 patients who attended the DN class held at our hospital from 2002 to 2010 and classified them into four groups using cutoff values obtained from ROC curves (urinary protein excretion [UP] 1.3 g/day, eGFR change from 6 months before the class to the time of the class [ΔeGFR] −0.3 mL/min/1.73 m²/month). The clinical characteristics of HD and non-HD patients were compared in each group. Patients who had UP ≥1.3 g/day at the time of participation in the class were at higher risk for the induction of HD and had a shorter time to induction. On the other hand, some patients with UP < 1.3 g/day had HD induction when UP at 1 year tended to be high regardless of the ΔeGFR value. Even in participants with group education, it was suggested that the amount of UP change influences the pathophysiological changes that lead to HD.