Objective: To determine the reducing rate of renal deterioration in a low resource setting among Indian Patients with CKD due to Diabetic kidney disease. Methods: A Prospective follow-up study was conducted among T2DM patients attended outpatient clinic over a period of one year in a tertiary care hospital. A total of 236 T2DM patients fall under Moderate Risk (MR) and High Risk (HR) categories (KDIGO classification) were included. Patients were randomized in to two groups. Group I (n = 121), received routine care of treatment and group II (n = 115) received an intensive blood pressure, lipids and glycemic control along with educational reinforcement with regular follow up. Results: All biochemical parameters were similar at baseline in both groups. However a significant reduction was observed at the end of follow-up period in BMI (p<0.0001), Systolic BP (p<0.0001), Diastolic BP (p<0.0001), HbA1c (p<0.0001), creatinine (p=0.004), Urea (p<0.0001), Total-cholesterol (p =0.0009), LDL-cholesterol (<0.005), HDL-Cholesterol (p=0.003) and increased eGFR (p<0.0001), in group II when compared to group I. At baseline in Group I, 58 and 63 patients and Group II, 56 and 59 patients were in MR and HR category. At the end of follow-up period, 30.35 % of patients become normo-albuminuric, in group II from MR category. In group I, 20.68% of subjects progressed from MR to HR and 17.46% progressed from HR to VHR category, whereas in Group II none of the patients progressed from MR to HR. Similarly in Group I, 12.69 % of HR patients were converted to MR, where as in Group II, higher percentage of HR (20.33%) patients were converted to MR category. Conclusion: Study finding highlighted that intensive multi factorial intervention can lower the risk of diabetic nephropathy among T2DM patients who are at higher risk and a combined intensified management strategy is superior over conventional therapy.
