Progression of chronic kidney disease in patients with hypertension or type 2 diabetes mellitus, can it be delayed?

A quantitative approach with quasi-experimental, one group pretest- posttest design was used in this study. The aim of this study was to find the effect of a Disease Management Program (DMP) on delaying progression of Chronic Kidney Disease in patients with hypertension or type 2 diabetes mellitus.

The participants were the people diagnosed with hypertension and/or diabetes for five or more year's duration and treatment. People visiting rural health centers of Udupi District, Karnataka State, India, aged 30 years and above were the sampled population selected through enumerative sampling technique. Sample size calculated to reach statistical significance with a power of 0.8, a standard deviation of eight, decline in eGFR in one year of five, and significance level 0.05, the total sample required was 22 each in stages 1, 2, and 3 of CKD. Keeping a 5% nonresponse rate total sample estimated was 70. The Chronic Kidney Disease stage was known after the serum creatinine test and formula application; hence the total sample taken was 103. Out of 103, for one year, 15 participants failed to follow up and hence 88 samples were analyzed.

Study instruments

The data were collected using demographic proforma which includes, age, gender, height, weight, serum creatinine, blood pressure, and RBS, hypertension, and diabetes mellitus status, and duration of illness. A calibrated weighing scale was used to measure the weight. New measuring tape, sphygmomanometer, and glucometer were used to assess the height, blood pressure, and blood sugar, respectively. The intervention, DMP, refers to educating the participants about the management of hypertension or diabetes mellitus on a one-to-one basis (explaining and giving leaflets) and follows up on every fourth month, till one year, with teaching reinforcement along with random blood sugar and blood pressure assessment, as well.

Development of the education module and leaflet about hypertension and diabetes mellitus was prepared by the researcher by reviewing the published and unpublished literature and validated by experts. The education module contains the meaning, causes and risk factors, signs and symptoms, diagnosis, and management. Management included nutrition, exercise, monitoring of blood sugar and blood pressure, pharmacologic therapy. An explanation about the disease is given in a simple, understandable way, and doubts raised by patients were cleared. Complications were explained to improve the compliance level. The importance of exercise, nutrition, and compliance with medication in controlling blood sugar and blood pressure were also explained.

The researcher filled the demographic proforma by collecting information from the participants and assessed height, weight, blood pressure, and Random Blood Sugar (RBS). Blood for serum creatinine was collected using serum vacutainer and assessed using the standard Jaffe method calibrated to Isotope Dilution Mass Spectrometry (IDMS). CKD-EPI formula was used to estimate GFR. Teaching was given about managing hypertension and diabetes mellitus, and a leaflet about the same was distributed during the baseline data collection. Fourth and eighth-month blood pressure and RBS were reassessed, and teaching was reinforced. At one-year blood pressure, RBS, and serum creatinine were tested.

Study variables

Demographic variables were age, gender, serum creatinine height, and weight. Teaching regarding management of Hypertension and Diabetes Mellitus is the independent variable. Blood pressure and RBS were the dependent variables that affect kidney function and eGFR is the key variable. Other variables are disease conditions (Diabetes Mellitus or Hypertension   or both) and duration of illness..