Predictors of chronic kidney disease survival in type 2 diabetes: a 12-year retrospective cohort study utilizing estimated glomerular filtration rate.

Predicting the course of kidney disease in individuals with both type 1 and type 2 diabetes mellitus (DM) is a significant clinical and policy challenge. In several regions, DM is now the leading cause of end-stage renal disease. The aim of this study to identify both modifiable and non-modifiable risk factors, along with clinical markers and coexisting conditions, that increase the likelihood of stage 3-5 chronic kidney disease (CKD) development in individuals with type 2 DM in the United Arab Emirates (UAE). This was a single-center retrospective cohort study based on data derived from electronic medical records of UAE patients with DM who were registered at outpatient clinics at Tawam Hospital in Al Ain, UAE, between January 2011 and December 2021. Type 2 DM patients aged ≥ 18 years who had serum HbA1c levels ≥ 6.5% were included in the study. Patients with type 1 DM, who had undergone permanent renal replacement therapy, who had under 1 year of follow-up, or who had missing or incomplete data were excluded from the study. Factors associated with diabetic patients developing stage 3-5 CKD were identified through Cox regression analysis and a fine and gray competing risk model to account for competing events that could potentially hinder the development of CKD. A total of 1003 patients were recruited for the study. The mean age of the study cohort at baseline was 70.6 ± 28.2 years. Several factors were found to increase the risk of developing stage 3-5 CKD: advancing age (HR 1.005, 95% CI 1.002-1.009, p = 0.026), a history of hypertension (HR 1.69, 95% CI 1.032-2.8, p = 0.037), a history of heart disease (HR 1.49, 95% CI 1.16-1.92, p = 0.002), elevated levels of serum creatinine (HR 1.006, 95% CI 1.002-1.010, p = 0.003), decreased levels of estimated glomerular filtration rate (eGFR) (HR 0.943, 95% CI, 0.938-0.947; p < 0.001), and the use of beta-blockers (HR 139, 95% CI 112-173, p = 0.003). Implementing preventative measures, initiating early interventions, and developing personalized care plans tailored to address specific risk factors are imperative for reducing the impact of CKD. Additionally, the unforeseen findings related to eGFR highlight the ongoing need for research to deepen our understanding of the complexities of kidney disease.

A pilot study on generic medicine substitution practices among community pharmacists in the State of Penang, Malaysia.

PURPOSE: The purpose of this study was to evaluate the generic substitution (GS) practices undertaken by community pharmacists in the State of Penang, Malaysia with a focus on the extent of communication between pharmacists and prescribers on issues related to GS, consumer's acceptance on the GS and estimation of cost saving achieved for patients opted for GS. METHOD: A cross-sectional descriptive study for a period of 2 months using a specific questionnaire as a data collection tool was undertaken with a random sample of 40 community pharmacies located in the State of Penang. RESULTS: By the end of the study period, 34 out of 40 pharmacies contacted participated in the study. Forty-seven per cent of pharmacists consulted prescribers while promoting GS to their consumers. Majority of the prescribers (84.4%) when contacted by the pharmacists accepted the suggestion for substitution. From consumers' perspective, 88% (n = 156) of the consumers involved in this study accepted pharmacist's recommendation to generically substitute their prescribed medications. Through acceptance of GS, it has been estimated that the overall consumers' expenses on drugs can be reduced to a total of RM6137 (US$1615; US$1 = RM3.80) and this corresponds to a cost saving of 61.1%. CONCLUSIONS: The outcome of the present study showed that through GS recommendation by community pharmacist, consumers can save the expenditure of their prescribed medications.