The Nephrologist’s Role in the Collaborative Multi-Specialist Network Taking Care of Patients with Diabetes on Maintenance Hemodialysis: An Overview

Abstract

Diabetes mellitus is the leading cause of renal failure in incident dialysis patients in several countries around the world. The quality of life for patients with diabetes in maintenance hemodialysis (HD) treatment is in general poor due to disease complications. Nephrologists have to cope with all these problems because of the “total care model” and strive to improve their patients’ outcome. In this review, an updated overview of the aspects the nephrologist must face in the management of these patients is reported. The conventional marker of glycemic control, hemoglobin A1c (HbA1c), is unreliable. HD itself may be responsible for dangerous hypoglycemic events. New methods of glucose control could be used even during dialysis, such as a continuous glucose monitoring (CGM) device. The pharmacological control of diabetes is another complex topic. Because of the risk of hypoglycemia, insulin and other medications used to treat diabetes may need dose adjustment. The new class of antidiabetic drugs dipeptidyl peptidase 4 (DPP-4) inhibitors can safely be used in non-insulin-dependent end-stage renal disease (ESRD) patients. Nephrologists should take care to improve the hemodynamic tolerance to HD treatment, frequently compromised by the high level of ultrafiltration needed to counter high interdialytic weight gain. Kidney and pancreas transplantation, in selected patients with diabetes, is the best therapy and is the only approach able to free patients from both dialysis and insulin therapy.

Relación entre bienestar psicológico y la percepción de calidad de vida en pacientes en hemodiálisis

“…Características clínicas del paciente con ERC en HD como la DM de forma aislada o cursando de forma concomitante con hipertensión arterial, repercute con índices inferiores en las categorías y dimensiones valoradas con los dos instrumentos, tal como en las puntuaciones generales consolidadas de ambas variables. Estos resultados se respaldan por la literatura, que exhiben que la presencia de sintomatología depresiva, ansiedad y peores percepciones de calidad de vida, se relacionan positivamente con el paciente en HD que tiene ésta comorbilidad 30 .…”

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients—A Review PART II—Pharmacological Approach for Management of Elderly Patients with Peripheral Atherosclerotic Lesions outside Coronary Territory

“…The position of new antidiabetic agents in patients presenting with RAS and ICAS is unclear. From observational data and nephrologists’ opinions, the use of SGLT2is can contribute to a significant renal function deterioration in patients with RAS due to their mechanism of action [ 150 , 195 ]. However, it is not determined whether the use of GLP-1 receptor analogues and DDP-4 would be a better choice in patients with RAS, as adequate clinical studies are missing.…”

Factors Contributing to Negative Outcomes Associated with Medications and Drug-Related Problems in Kidney Replacement Therapy—A Hospital-Based Prospective Observational Study

“…The intricacies inherent in KRT present formidable medical challenges, compelling the use of a plethora of medications to address associated comorbidities [6]. These health conditions, in turn, impose substantial financial strains on healthcare systems.…”