Diabetic patients represent the largest group requiring renal replacement therapy in the developed nations, although take-on rates in the UK still lag behind other countries. As a group, diabetic patients present specific challenges to those providing renal replacement, including disproportionate late referral and under-recognition of renal insufficiency, multiple co-morbidity, and issues relating to choice of dialysis modality and when dialysis should be started. This review explores these issues and argues that it is by concentrating on the pre-dialysis phase of care that clinicians are most likely to achieve a more favourable clinical outcome. In addition to the benefits of good blood pressure and diabetic control, time is needed to inform and educate the patient prior to dialysis, and to evaluate co-morbidity if transplantation is to be considered. To achieve this, patients require nephrological supervision in the context of a well-resourced, multidisciplinary pre-dialysis programme, commencing a minimum of one year before starting renal replacement therapy.
Ritz E., Tarng DCRenal disease in type 2 diabetes. Nephrol Dial Transplant2001;16(S5):11-18.
2.
UK Renal Registry Report2000: Bristol , UK Renal Registry.
3.
Raine AEEpidemiology, development and treatment of end-stage renal failure in type 2 (non-insulin-dependent) diabetic patients in Europe. Diabetologia1993;36:1099-104.
4.
Arora P., Obrador GT, Ruthazer R. et al. Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center. J Am Soc Nephrol1999;10:1281-6.
5.
Levin A.Consequences of late referral on patient outcomes. Nephrol Dial Transplant2000;15(S3):8-13.
6.
Goodkin DA, Mapes DL, Held PJThe dialysis outcomes and practice patterns study (DOPPS): how can we improve the care of hemodialysis patients?Semin Dial2001;14:157-9.
7.
Crook ED, Harris J., Oliver B. et al. Endstage renal disease owing to diabetic nephropathy in Mississippi: an examination of factors influencing renal survival in a population prone to late referral. J Investig Med2001;49:284-91.
8.
Maynard C., Cordonnier D.The late referral of diabetic patients with kidney insufficiency to nephrologists has a high human and financial cost: interdisciplinary communication is urgently needed. Diabetes Metab2001;27:517-21.
9.
Levey AS, Bosch JP, Lewis JB et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med1999;130:461-70.
10.
Merkus MP, Jager KJ, Dekker FW et al. Predictors of poor outcome in chronic dialysis patients: The Netherlands Cooperative Study on the Adequacy of Dialysis. The NECOSAD Study Group. Am J Kidney Dis2000;35:69-79.
11.
Khan IH, Campbell MK, Cantarovich D. et al. Survival on renal replacement therapy in Europe: is there a 'centre effect'?Nephrol Dial Transplant1996 ;11:300-07.
12.
Fried L., Bernardini J., Piraino B.A comparison of the Charlson comorbidity index and the Davies score to predict outcomes in incident PD patients. Perit Dial Int2001;21:S22.
13.
Davies SJ, Philipps L., Naish PF et al. Quantifying comorbidity in Peritoneal Dialysis patients and its relationship to other predictors of survival. Nephrol Dial Transplant2002;(in press).
14.
NKF-DOQI clinical practice guidelines for peritoneal dialysis adequacy.National Kidney Foundation . Am J Kidney Dis1997;30(S2):S67-136.
15.
Churchill DN , Taylor DW, Keshaviah PRAdequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcome. J Am Soc Nephrol1996;7:198-207.
16.
Churchill DNAn evidence-based approach to earlier initiation of dialysis. Am J Kidney Dis1997;30:899-906.
17.
Korevaar JC , Jansen MA, Dekker FW et al. When to initiate dialysis: effect of proposed US guidelines on survival. Lancet2001;358:1046-50.
18.
Moist LM, Port FK, Orzol SM et al. Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol2000;11:556-64.
19.
Singhal MK, Bhaskaran S., Vidgen E. et al. Rate of decline of residual renal function in patients on continuous peritoneal dialysis and factors affecting it. Perit Dial Int2000;20:429-38.
20.
Fenton SSA , Schaubel DE, Desmeules M. et al. Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis1997;30:334-42.
21.
Heaf JG, Lokkegaard H., Madsen M.Initial survival advantage of PD relative to HD. Nephrol Dial Transplant2001;16:A161.
22.
Collins AJ, Hao W., Xia H. et al. Mortality risks of peritoneal dialysis and hemodialysis. Am J Kidney Dis1999;34:1065-74.
23.
Merkus MP, Jager KJ, Dekker FW et al. Physical symptoms and quality of life in patients on chronic dialysis: results of The Netherlands Cooperative Study on Adequacy of Dialysis (NECOSAD). Nephrol Dial Transplant1999;14:1163-70.
24.
Van Biesen W. , Vanholder RC, Veys N. et al. An evaluation of an integrative care approach for end-stage renal disease patients. J Am Soc Nephrol2000;11:116-25.
25.
Vonesh EF, Moran J.Mortality in end-stage renal disease: a reassessment of differences between patients treated with hemodialysis and peritoneal dialysis. J Am Soc Nephrol1999;10:354-65.
Breckenridge DMPatients' perceptions of why, how, and by whom dialysis treatment modality was chosen. Anna J1997;24:313-19; discussion 320-21.
28.
Szabo E., Moody H., Hamilton T. et al. Choice of treatment improves quality of life. A study on patients undergoing dialysis. Arch Intern Med1997;157:1352-6.
29.
Rasgon SA, Chemleski BL, Ho S. et al. Benefits of a multidisciplinary predialysis program in maintaining employment among patients on home dialysis. Adv Perit Dial1996;12:132-5.
30.
Levin A., Lewis M., Mortiboy P. et al. Multidisciplinary predialysis programs: quantification and limitations of their impact on patient outcomes in two Canadian settings. Am J Kidney Dis1997;29:533-40.
