- Diabetes mellitus
- End-stage renal disease
- Diabetic nephropathy
- Renal replacement therapy
- Maintenance hemodialysis
The prevalence of diabetes mellitus (DM) is very high worldwide. According to the World Health Organization in 2000 the worldwide prevalence of DM was 171,000,000. Diabetic nephropathy is a major vascular complication of DM. If DM is not treated early and adequately, many diabetic patients may reach end-stage renal disease (ESRD) secondary to advanced irreversible diabetic nephropathy. In many countries diabetic nephropathy has become the single most frequent cause of prevalent ESRD patients undergoing maintenance hemodialysis (MHD). In the early era of renal replacement therapy (RRT) by means of intermittent hemodialysis the prognosis of diabetic patients undergoing MHD was extremely poor and disappointing. While the prognosis of patients suffering from diabetic ESRD and maintained by chronic intermittent dialysis has greatly improved, the rehabilitation rate and survival of these patients continue to be worse than those of non-diabetic patients. A preexisting severely compromised cardiovascular condition, vascular access problems, diabetic foot disease, interdialytic weight gain, and intradialytic hypotension explain most of the less favorable outcome. Despite improved techniques and more aggressive medical therapy in recent years, a review of the fate of diabetics in dialysis units since 1972 reveals that these patients have had significant morbidity and mortality. We still have a long way to go in order to achieve more ideal outcomes for our patients. Most of the diabetic ESRD patients are still maintained by MHD, but they can choose other modalities of RRT such as chronic ambulatory peritoneal dialysis (CAPD), kidney and kidney plus pancreas transplantation. The results of different studies and national registries on the mortality and morbidity of ESRD patients being maintained on different modalities of dialysis are conflicting. It can be concluded that the two modalities of dialysis (CAPD and MHD) are almost comparable in terms of survival. The recent suggestions for nocturnal daily hemodialysis, short daily hemodialysis, and an integrative care approach for the management of diabetics with ESRD provides better promise for these patients.
Copyright © 2007 S. Karger AG, Basel
- World Health Organization: Burden of Disease Project. Available at http://www3.who.int/whosis/menu.cfm=evidence,burden& language=english.
- US Renal Data System: 2005 Report. Bethesda MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Am J Kidney Dis 2006;47(suppl 1):s65–s80.
- Mailloux LU: Dialysis in diabetic nephropathy 2006UpToDate online 14.1.
- Nobakht Haghighi A, Broumand B, D’Amico M, Locatelli F, Ritz E: The epidemiology of end-stage renal disease in Iran in an international perspective. Nephrol Dial Transplant 2002;17:28–32.
- Locatelli F, Rozzoni P, Del Vecchio L: Renal replacement therapy in patients with diabetes and end-stage renal disease. J Am Soc Nephrol 2004;15:525–529.
- Oeppen J, Vaupel JW: Demography: broken limits to life expectancy. Science 2002;296:1029–1031.
- Human Development Report 2004. United Nations Development Program, p 154.
- Dunea G: Peritoneal dialysis and hemodialysis. Med Clin North Am1971;55:155–160.
- Ghavamian M, Gutch CF, Kopp KF, Kolff WJ: The sad truth about hemodialysis in diabetic nephropathy. JAMA 1972;222:1386–1389.
- Ginn HE: Intermittent hemodialysis. The Kidney 1974;7:3–6.
- Bricker NS, Fine LG, Kaplan MA, Epstein M, Bourgoignie GG, Licht A: Magnification phenomenon in chronic renal disease. N Engl J Med 1978;299:1287–1293.
- Fine LG: The uremic syndrome: adaptive mechanisms and therapy. Hosp Pract (Off Ed) 1987;22:63–73.
- Adamson JW, Eschbach JW, Finch CA: The kidney and erythropoiesis. Am J Med 1968;44:725–733.
- Eschbach JW, Egrie JC, Downing MR, Browne JK, Adamson JW: Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. N Engl J Med 1987;316:73–78.
- Eschbach JW: Erythropoietin therapy for the anemia of chronic renal failure. The kidney 1990;22:1–6.
- Thomas M, Tsalamandris C, MacIsaac R, Jerums G: Anaemia in diabetes: an emerging complication of microvascular disease. Curr Diabetes Rev 2005;1:107–126.
- McClellan W, Aronoff SL, Bolton WK, et al: The prevalence of anemia in patients with chronic kidney disease. Curr Med Res Opin 2004;20:1501–1510.
- Ritz E, Haxsen V: Diabetic nephropathy and anemia. Eur J Clin Invest 2005;35(suppl 3):66–74.
- KDOQI; National Kidney Foundation: KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis 2006;47(suppl 3):S11–S15.
- Eknoyan G, Beck GJ, Cheung AK, et al; Hemodialysis (HEMO) Study Group: Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002;347:2010–2019.
- Moore DAJ, Lightstone L, Javid B, Friedland JS: High rates of tuberculosis in end-stage renal failure: the impact of international migration. Emerg Infect Dis 2002;8:77–78.
- Kopple JD: Effect of nutrition on morbidity and mortality in maintenance dialysis patients. Am J Kidney Dis 1994;24:1002–1009.
- Mailloux LU: 2006 UpToDate; Online14.1: Dialysis in diabetic nephropathy.
- Kalantar-Zadeh K, Kopple JD: Relative contribution of nutrition and Inflammation to clinical outcome in dialysis patients. Am J Kidney Dis 2001;38:1343–1350.
- Kaysen GA, Chertow GM, Adhikarla R, Young B, Ronco C, Levin NW: Inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients. Kidney Int 2001;60:333–340.
- Hirokazu H, Qureshi AR, Heimburger O, Barany P, Wang K, Pecoits-Filho R, Stenvikel P, Lindholm B: Serum albumin, C-reactive, interleukin 6, and fetuin A as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis 2006;47:139–148.
- Dikow R, Ritz E: Cardiovascular complications in the diabetic patient with renal disease: an update in 2003. Nephrol Dial Transplant 2003;18:1993–1998.
- Varghese K, Cherian G, Abraham MT, Hayat NJ, Jony KV: Coronary artery disease among diabetic and non-diabetic patients with end stage renal disease. Ren Fail 2001;23:669–677.
- Morika T, Emoto M, Tabata T, Shoji T, Tahara H, Kishimoto H, Ishimura E, Nishizawa Y: Glycemic control is a predictor of survival for diabetic patients on hemodialysis. Diabetes Care 2001;24:909–913.
- Shinaberger CS, Kalantar-Zadeh K, Regidor DL, Kilpatrick RD, Aronovitz J, McAllister Ch, Whellan D, Sharma K: Hemoglobin A1c and survival in maintenance hemodialysis patients. ASN’s 39th Annual Renal Week Meeting, Nov 2006.
- Davenport A: Intradialytic complications during hemodialysis. Hemodial Int 2006;10:162–167.
- Sangill M, Pedersen EB: The effect of glucose added to the dialysis fluid on blood pressure, blood glucose, and quality of life in hemodialysis patients: a placebo-controlled crossover study. Am J Kidney Dis 2006;47:636–643.
- Chang MH, Chou KJ: The role of autonomic neuropathy in the genesis of intradialytic hypotension. Am J Nephrol 2001;21:357–361.
- Chiladakis J, Patsouras N, Manolis A: The Bezold-Jarisch reflex in acute inferior myocardial infarction: clinical and sympathovagal spectral correlates. Clin Cardiol 2003;26:323–328.
- Landry DW, Oliver JA: Blood pressure instability during hemodialysis. Kidney Int 2006;69:1710–1711.
- van den Hoogan PCW, Feskens EJM, Nagelkerke NJD, et al: The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. N Engl J Med 2000;342:1–8.
- Kalantar-Zadeh K, Block G, Humphrey MH, Kopple JD: Reverse epidemiology of cardiovascular risk factor in maintenance dialysis patients. Kidney Int 2003;63:793–808.
- Eggers PW, Gohdes D, Pugh J: Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. Kidney Int 1999;56:1524–1533.
- Schomig M, Ritz E, Standl E, Allenberg J: The diabetic foot in the dialyzed patient. J Am Soc Nephrol 2000;11:1153–1159.
- Ikizler TA, Schulman G: Hemodialysis: techniques and prescription. Am J Kidney Dis 2005;46:976–981.
- Nobakht Haghighi A, Nobakht Haghighi N, Nowroozi A, Rhabar K, Broumand B: Outcome of diabetic patients on chronic hemodialysis in Tehran – Iran during last ten years. J Am Soc Nephrol 2002;13:687A.
- Jaar BG, Coresh J, Plantinga LC, Fink NE, Klag MJ, Levy AS, Levin NW, Sadler JH, Kiliger A, Powe NR: Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. Ann Intern Med 2005;143:174–183.
- Ayus JC, Mizani MR, Achinger SG, Thadhani R, Go AS, Lee S: Effects of short daily versus conventional hemodialysis on left ventricular hypertrophy and inflammatory markers: a prospective, controlled study. J Am Soc Nephrol 2005;16:2778–2788.
- Zimmerman SW, Sollinger H, Wakeen M, et al: Renal replacement therapy in diabetic nephropathy. Adv Ren Replace Ther 1994;1:66–74.
- Pierratos A, Quwendyk M, Rassi M: The body nitrogen increases on nocturnal hemodialysis. J Am Soc Nephrol 1999;10:299A.
- Van Biesen W, Vanholder RC, Veys N, Dhondt A, Lameire N: An evaluation of an integrative care approach for end-stage renal disease patients. J Am Soc Nephrol 2000;11:116–125.
Behrooz Broumand, MD
Iran University of Medical Sciences
7 Daroogar Alley, Mehmanoost St., Farmanieh Ave.
Tehran 19549 (Iran)
Tel. +98 21 2228 3658, Fax +98 21 8872 1141, E-Mail V4broumand@yahoo.com
Published online: December 14, 2006
Number of Print Pages : 9
Number of Figures : 6, Number of Tables : 2, Number of References : 46
Vol. 25, No. 1, Year 2007 (Cover Date: December 2006)
Journal Editor: Leunissen, K.M.L. (Maastricht)
ISSN: 0253–5068 (print), 1421–9735 (Online)
For additional information: http://www.karger.com/BPU
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