Clinical study on the optimization of dialysis timing and blood glucose control in patients with chronic glomerulonephritis complicated with diabetes
慢性肾小球肾炎合并糖尿病患者透析时机优化与血糖控制的临床研究

摘要

目的 探究慢性肾小球肾炎合并糖尿病患者的优化透析时机及强化血糖控制策略对临床疗效的影响。方法 选取2023年3月—2024年3月我院收治的慢性肾小球肾炎合并糖尿病患者60例，采用随机数字表法分两组。对照组在估算肾小球滤过率（eGFR）≤10 mL/（min•1.73m2）时启动维持性血液透析，配合常规血糖控制；观察组在eGFR 12~15 mL/（min•1.73m2）时启动维持性血液透析，采用强化血糖控制。比较两组肾功能指标、血糖控制指标及并发症发生情况。结果 治疗12个月后，观察组Scr、BUN、UA水平均低于对照组，eGFR水平高于对照组；治疗12个月后，观察组空腹血糖、餐后2h血糖及HbA1c水平均优于对照组；观察组的总发生率低于对照组（P＜0.05）。结论 对慢性肾小球肾炎合并糖尿病患者，在eGFR 12~15 mL/（min•1.73m2）时启动透析并联合强化血糖控制，可改善肾功能、提升血糖控制效果、减少并发症，进而提高生存质量，具有临床推广价值。

Abstract

Objective To explore the impact of optimizing dialysis timing and strengthening blood glucose control strategies on the clinical efficacy of patients with chronic glomerulonephritis complicated with diabetes.
Methods Sixty patients with chronic glomerulonephritis complicated with diabetes mellitus admitted to our hospital from March 2023 to March 2024 were selected and divided into two groups by random number table method. In the control group, maintenance hemodialysis was initiated when the estimated glomerular filtration rate (eGFR) was ≤10 mL/ (min•1.73m²), combined with conventional blood glucose control. In the observation group, maintenance hemodialysis was initiated when the eGFR was 12-15 mL/ (min•1.73m²), and intensive blood glucose control was adopted. The renal function indicators, blood glucose control indicators and the occurrence of complications were compared between the two groups.
Results After 12 months of treatment, the levels of Scr, BUN and UA in the observation group were all lower than those in the control group, and the level of eGFR was higher than that in the control group. After 12 months of treatment, the fasting blood glucose, 2-hour postprandial blood glucose and HbA1c levels in the observation group were all better than those in the control group. The total incidence rate of the observation group was lower than that of the control group (P < 0.05).
Conclusion   For patients with chronic glomerulonephritis complicated with diabetes, initiating dialysis at eGFR 12-15 mL/ (min•1.73m²) and combining it with intensive blood glucose control can improve renal function, enhance the effect of blood glucose control, reduce complications, and thereby improve the quality of life, which has clinical promotion value.