2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Locatelli, F. Articles by Del Vecchio, L. Search for Related Content PubMed PubMed Citation Articles by Locatelli, F. Articles by Del Vecchio, L.

Renal Replacement Therapy in Patients with Diabetes and End-Stage Renal Disease

Department of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy

Correspondence to Prof. Francesco Locatelli, Department of Nephrology and Dialysis, A. Manzoni Hospital, Via dell’Eremo 9/11, 23900 Lecco, Italy. Phone: +39-0341-489850; Fax: +39-0341-489860; E-mail: nefrologia{at}ospedale.lecco.it

ABSTRACT. The number of patients who have diabetes and ESRD and are being admitted to renal replacement treatment (RRT) is increasing dramatically worldwide, and in many countries, diabetes has become the single most frequent cause of ESRD. Although the prognosis of patients who have diabetes and are receiving RRT has greatly improved, survival and medical rehabilitation rates continue to be significantly worse than those of nondiabetic patients, mainly because of preexisting severely compromised cardiovascular conditions. The most common RRT modality in patients with diabetes is still hemodialysis, but it gives rise to a number of clinical problems, in particular difficulties in the management of the vascular access and high frequency of intradialytic hypotension. However, patients who have diabetes and are on peritoneal dialysis have to face a progressive increase in peritoneal permeability, loss of ultrafiltration, and peritoneal fibrosis, all phenomena being accelerated in patients with diabetes and ultimately leading to an increased technique failure. The results of observational studies and national registries, although conflicting, suggest that these two dialytic modalities are somehow comparable in terms of outcomes, whereas accumulating evidence shows that both survival and medical rehabilitation of patients with diabetes are significantly better after renal transplantation, which should be the first-choice option for patients who have diabetes and reach ESRD but unfortunately still accounts for only a limited proportion of RRT treatments in these patients.

This article has been cited by other articles:

				T. Q. Nguyen, L. Tarnow, A. Jorsal, N. Oliver, P. Roestenberg, Y. Ito, H.-H. Parving, P. Rossing, F. A. van Nieuwenhoven, and R. Goldschmeding Plasma Connective Tissue Growth Factor Is an Independent Predictor of End-Stage Renal Disease and Mortality in Type 1 Diabetic Nephropathy Diabetes Care, June 1, 2008; 31(6): 1177 - 1182. [Abstract] [Full Text] [PDF]

				E. Villar, S. H. Chang, and S. P. McDonald Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991 2005) Diabetes Care, December 1, 2007; 30(12): 3070 - 3076. [Abstract] [Full Text] [PDF]

				J. Asbun and F. J. Villarreal The Pathogenesis of Myocardial Fibrosis in the Setting of Diabetic Cardiomyopathy J. Am. Coll. Cardiol., February 21, 2006; 47(4): 693 - 700. [Abstract] [Full Text] [PDF]

				B. G. Jaar, J. Coresh, L. C. Plantinga, N. E. Fink, M. J. Klag, A. S. Levey, N. W. Levin, J. H. Sadler, A. Kliger, and N. R. Powe Comparing the Risk for Death with Peritoneal Dialysis and Hemodialysis in a National Cohort of Patients with Chronic Kidney Disease Ann Intern Med, August 2, 2005; 143(3): 174 - 183. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673