The burden of diabetes-related chronic kidney disease ( CKD ) on individuals and society is increasing, shifting attention to improving the quality of care for patients with CKD and diabetes . Researchers assessed the quality of CKD care and its association with long-term dialysis, acute kidney injury (AKI), and death.

Researchers conducted a cohort study using data from the Longitudinal Cohort of Diabetes Patients database ( LHDB ) from the National Health Insurance ( NHI ) Research Database of Taiwan.

The LHDB is a sub-data set comprising a randomly sampled cohort of patients with diabetes from the NHI Research Database, which is constructed and maintained by the National Health Research Institutes, Taiwan.

CKD-care quality indicators based on medical and pharmacy claims data were studied: prescription of renin-angiotensin system inhibitors, testing for proteinuria, and nutritional guidance. Each was examined individually, and all were summed into an overall quality score.

The primary outcome was initiation of long-term dialysis therapy. Secondary outcomes were hospitalization due to AKI and death from any cause. The observation period started on the date and ended on the date of the outcome or December 31, 2011, whichever occurred earlier. 

Using instrumental variables related to the quality indicators to minimize both unmeasured and measured confounding, fit to 2-stage residual inclusion model to estimate HRs and 95% CIs for each outcome.

Among the 63,260 patients enrolled, 43.9% were prescribed renin-angiotensin system inhibitors, 60.6% were tested for proteinuria, and 13.4% received nutritional guidance. During a follow-up of 37.9 months, 1,471 patients started with long-term dialysis therapy, 2,739 patients were hospitalized due to AKI, and 4,407 patients died.

Higher overall quality scores were associated with lower hazards for long-term dialysis in instrumental variable analyzes (HR of 0.62 [95% CI, 0.40-0.98] per 1-point greater score) and hospitalization due to AKI (HR of 0.69 [95% CI, 0.50-0.96] per 1-point greater score). The hazard for all-cause death was nonsignificantly lower (HR of 0.80 [95% CI, 0.62-1.03] per 1-point greater score).

Conclusions The CKD care improves the chances to improve long-term outcomes among patients with diabetes and CKD .