National survey: Evaluation of cardiovascular risk factors in Thai patients with type 2 diabetes and chronic kidney disease after the development of cardiovascular disease

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The prevalence of chronic kidney disease (CKD) is increasing globally. The reasons for the increase in the prevalence of CKD result from the high prevalence of diabetes mellitus (DM) and the increasingly elderly population.1 In addition, it has been known that patients with CKD or DM are at risk for the development of cardiovascular disease (CVD), which include stroke, coronary heart disease, and peripheral arterial disease.3 There are higher mortality rates in CKD patients with CVD as compared to the mortality from end‐stage renal disease (ESRD).7 The mortality rate for CVD patients with CKD is higher than those patients with normal renal function.8
The traditional risk factors which have been established being the major determinants for development of CVD in patients with CKD are hypertension, diabetes, dyslipidaemia, smoking, obesity and a lack of regular physical activity.9 Several studies have shown that effective treatment of diabetes, hypertension and dyslipidemia could lower risk of CVD events.10 The study from USA using National Health and Nutritional Examination Survey (NHANES) data from 2001 to 2010 found that nearly 50% of USA adults with estimated glomerular filtration rate (eGFR) <45 mL/min per 1.73 m2 had concomitant CVD.17 It also showed that there were low proportions of CKD patients concomitant with CVD or with diabetes achieving recommended low‐density lipoprotein cholesterol (LDL‐C) or blood pressure (BP) therapeutic goals.17 Moreover, it has been studied that the patients who survived coronary heart disease had higher rates of recurrence and previous ischaemic stroke is a risk factor for recurrent primary intracerebral haemorrhage.16
The burden from non‐communicable diseases has risen in Thailand.19 The Thai SEEK study has shown that the prevalence of CKD was 17.5%.20 In the past, the main problem of the health system in Thailand was from the gap in equal accessibility to health services as only 25% of the Thai population had been covered by one of these health coverage schemes; civil servants medical benefit scheme and social security health coverage.21 Now, this gap has been closed as all the uninsured Thai people have the Universal health coverage (UC) scheme, which was implemented in 2002.22 The benefit package of UC has included care both in‐patient and out‐patient, medical prescriptions, laboratory investigations, disease prevention and health promotion. Therefore, we have selected to evaluate the quality of care for controlling risk factors in Thai patients with T2DM and CKD after the development of cardiovascular disease. These patients are very high risk population and therapeutic goals to prevent the controllable risks can practically be achieved.

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