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

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.

Identification of a New RNA and Protein Integrated Biomarker Panel Associated with Kidney Function Impairment in DKD: Translational Implications

“…DKD represents a very relevant clinical complication of diabetes. Indeed, it is the main cause of end-stage kidney disease in developed and developing countries and the most common reason for renal replacement therapy [28,29]. Furthermore, this condition is associated with an increase in cardiovascular morbidity and mortality [30].…”

H2S-based fluorescent imaging for pathophysiological processes

“…Diabetes, as a disease characterized by hyperglycemia, is related to diverse complications, including cardiovascular disease, stroke, kidney failure, neuropathy, retinopathy, and amputation (Al-Sofiani et al, 2019;Lau et al, 2019;Buades et al, 2021;Sempere-Bigorra et al, 2021;Milluzzo et al, 2021;O'neill et al, 2017). It is reported that diabetes can be divided into three types: Gestational diabetes, type 1 diabetes (T1D), and type 2 diabetes (T2D) (Xiang et al, 2018).…”

The capacity of stem cells in treatment of diabetes

“…Controlling diabetes type I requires regular intake of insulin on a daily and frequent basis, but diabetes type II can be controlled by using oral drugs which affect beta cells or the peripheral tissues [6]. There are 5 different groups of second-line antiglycemic medicines recommended by the ADA and EASD: dipeptidyl peptidase 4 (DPP-4) inhibitors, GLP-1RA inhibitors, SGLT2 inhibitors, sulfonylureas and thiazolidinediones [7].…”