Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options?

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Buades, Juan M. and Craver, Lourdes and Del Pino, Maria Dolores and Prieto Velasco, Mario and Ruiz, Juan C. and Salgueira, Mercedes and Sequera Ortiz, Patricia de and Vega, Nicanor (2021) Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options? Journal of Clinical Medicine, 10 (13). p. 2943. ISSN 2077-0383

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Official URL: https://doi.org/10.3390/jcm10132943




Abstract

Diabetic kidney disease (DKD) is the most frequent cause of kidney failure (KF). There are large variations in the incidence rates of kidney replacement therapy (KRT). Late referral to nephrology services has been associated with an increased risk of adverse outcomes. In many countries, when patients reach severely reduced glomerular filtration rate (GFR), they are managed by multidisciplinary teams led by nephrologists. In these clinics, efforts will continue to halt chronic kidney disease (CKD) progression and to prevent cardiovascular mortality and morbidity. In patients with diabetes and severely reduced GFR and KF, treating hyperglycemia is a challenge, since some drugs are contraindicated and most of them require dose adjustments. Even more, a decision-making process will help in deciding whether the patient would prefer comprehensive conservative care or KRT. On many occasions, this decision will be conditioned by diabetes mellitus itself. Effective education should cover the necessary information for the patient and family to answer these questions:
1. Should I go for KRT or not?
2. If the answer is KRT, dialysis and/or transplantation?
3. Dialysis at home or in center?
4. If dialysis at home, peritoneal dialysis or home hemodialysis?
5. If transplantation is desired, discuss the options of whether the donation would be from a living or deceased donor.
This review addresses the determinant factors with an impact on DKD, aiming to shed light on the specific needs that arise in the management and recommendations on how to achieve a comprehensive approach to the diabetic patient with chronic kidney disease


Item Type:Article
Uncontrolled Keywords:chronic kidney disease; diabetic kidney disease; hemodialysis; peritoneal dialysis; home hemodialysis; kidney transplant; kidney failure; kidney replacement therapy; comprehensive conservative care
Subjects:Medical sciences > Medicine > Nephrology and Urology
ID Code:68863
Deposited On:23 Nov 2021 09:38
Last Modified:23 Nov 2021 09:53

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