End‐stage renal failure and management of diabetes

Bilous, RW

doi:10.1111/j.1466-5468.2004.1180f.x

Cited by 11 publications

(8 citation statements)

References 9 publications

(9 reference statements)

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“…The International Diabetes Federation and the Japan Diabetes Society both recommend maintaining HbA 1c at <6.5% [33], whereas the American Diabetes Association recommends <7% [34]. Although our value of 7.3% is slightly higher than the target levels mentioned above, hypoglycaemia is a common medical problem in patients with haemodialysis [35]. Consideration should be given to the balance required between the benefit of lowering blood glucose and the risk of hypoglycaemia in patients with diabetes on haemodialysis.…”

Section: Discussionmentioning

confidence: 94%

Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

et al. 2007

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Aims/hypothesis There are few data on the target level of glycaemic control among patients with diabetes on haemodialysis. We investigated the impact of glycaemic control on mortality risk among diabetic patients on haemodialysis. Subjects and methods Data were analysed from the Dialysis Outcomes Practice Pattern Study (DOPPS) for randomly selected patients on haemodialysis in Japan. The diagnosis of diabetes at baseline and information on clinical events during follow-up were abstracted from the medical records. A Cox proportional hazards model was used to evaluate the association between presence or absence of diabetes, glycaemic control (HbA 1c quintiles) and mortality risk. Results Data from 1,569 patients with and 3,342 patients without diabetes on haemodialysis were analysed. Among patients on haemodialysis, those with diabetes had a higher mortality risk than those without (multivariable hazard ratio 1.37, 95% CI 1.08-1.74). Compared with those in the bottom quintile of HbA 1c level, the multivariable-adjusted hazard ratio for mortality was not increased in the bottom second to fourth quintiles of HbA 1c (HbA 1c 5.0-5.5% to 6.2-7.2%), but was significantly increased to 2.36 (95% CI 1.02-5.47) in the fifth quintile (HbA 1c ≥7.3%). The effect of poor glycaemic control did not statistically correlate with baseline mortality risk (p=0.27). Conclusions/interpretation Among dialysis patients, poorer glycaemic control in those with diabetes was associated with higher mortality risk. This suggests a strong effect of poor glycaemic control above an HbA 1c level of about 7.3% on mortality risk, and that this effect does not appear to be influenced by baseline comorbidity status.

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Section: Discussionmentioning

confidence: 94%

Diabetes, glycaemic control and mortality risk in patients on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

et al. 2007

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“…Ideal insulin therapies in diabetic patients with advanced CRF are difficult to establish given the lack of pharmacokinetic studies for the various types of insulin in patients with different degrees of renal insufficiency and the absence of therapeutic guidelines that define insulin adjustments based on GFR [43,93]. As regards type of insulin, whereas some authors recommend avoiding intermediate‐ and long‐acting insulins in CRF diabetics, others are active proponents [20,32].…”

Section: Insulin Therapy In Patients With Crfmentioning

confidence: 99%

Insulin therapy in renal disease

Iglesias

Díez

2008

Diabetes Obesity Metabolism

100

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Diabetes mellitus (DM) is the main cause of end-stage renal disease (ESRD). Conversely, chronic renal failure (CRF) is also associated with diverse alterations in carbohydrate and insulin metabolism. CRF-induced metabolic disorders should be borne in mind when treating diabetic patients, to ensure the introduction of adequate therapy adjustments that are in line with the onset of renal function decline. Moreover, several specific therapies employed in CRF may also influence pharmacological therapy of DM in uraemic patients. Adequate glycaemic control has also been associated with a reduction in the onset and progression of diabetic nephropathy as well as in the morbidity and mortality in uraemic diabetic patients during dialysis. Intensive insulin therapy can notably improve glycemic control and it should be considered part of the management of insulin-treated CRF diabetic patients. Insulin analogues have been recently evaluated in CRF diabetic patients, with encouraging results. In this study, we review the more relevant aspects related to insulin therapy in diabetic patients with different degrees of renal failure and in patients with ESRD, both in conservative therapy and dialysis.

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“…Contributing factors related to renal failure may include increased insulin resistance [14], prolonged insulin half-life [15], and/or reduced renal gluconeogenesis [8]. In this setting, insulin is recommended as a first-line therapy for type 2 diabetes [4][5][6]; however, physical and cognitive impairment due to aging and various comorbidities such as diabetic retinopathy may reduce compliance with insulin self-injection, contributing to inadequate glycemic control [13]. All hemodialysis patients in the present report were unable to self-inject insulin and had poor glycemic control before admission to the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…In uremic diabetic patients, insulin therapy is usually recommended as the first-line therapy [4][5][6]; however, some diabetic patients have poor compliance with insulin self-injection due to visual, motor, or cognitive impairment. In these patients, incenter injections of long-acting insulin after the dialysis session by medical staff may offer a potential option to improve diabetic management.…”

Section: Introductionmentioning

confidence: 99%