Adherence to blood pressure and glucose recommendations in chronic kidney disease hospital inpatients: Clinical inertia and patient adherence

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Abstract

Aims: To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Methods: Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Results: Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of <140/90 mmHg. The average CKD patient pre-admission BP was 134.8/72.2 mmHg compared to the discharge BP of 129.8/72.2 mmHg. At admission, 63.3% and 93.1% of patients adhered to systolic and diastolic BP recommendations, which significantly (p = < .05) increased at discharge to a systolic and diastolic BP adherence of 83.9% and 98.8%, respectively. The average random hospital BGL was 7.7 mmol/L, indicating good control, whereas the pre-hospital HbA1c average was 7.58%, indicating poor control (>7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = <.05) between clinical inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%). Conclusion: Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment.
Original languageEnglish
Pages (from-to)291-300
Number of pages10
JournalDiabetes and Metabolic Syndrome: Clinical Research and Reviews
Volume12
Issue number3
Early online dateDec 2017
DOIs
Publication statusPublished - May 2018

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