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Clinical Management of End-Stage Renal Disease and Hemodialysis Patients with Diabetes

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Special Issue Editor

Dr. Filippo Mariano

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Guest Editor

Department of Medical Sciences, University of Turin, 10124 Turin, Italy
Interests: critical care nephrology; acute kidne injury; continuous kidney replacement therapy; regional citrate anticoagulation; sepsis-associated acute kidney disease; burns-associated acute kidney disease

Special Issue Information

Dear Colleagues,

The rapid increase in the number of diabetic patients with end-stage renal disease (ESRD) in conservative or dialysis treatment is a global problem in the world, not only in western countries but also in Asia, Africa, and South America. This diabetic population is aged more than 65 years, largely due to the aging population of type II diabetes. Diabetic nephropathy is a chronic disease, most often progressive, and hence serious for associated comorbidities such as peripheral vascular ischemic disease, heart arrhythmia, and pulmonary chronic disease. Most patients undergo in-center hemodialysis (HD), and few patients undergo PD and kidney transplantation. To best deal with the clinical management of diabetics with severe renal failure, many questions remain open, such as the use in these patients of the new oral antidiabetic drugs (SGLT2i, GLP1RA and DDP-4i) or of NOACs for atrial fibrillation. In addition, we must consider during the conservative treatment the role of the diet, of metformin and the risk of lactic acidosis, and later the type and modality of dialysis, the organization of care, and all of the new tools that technology offers for improving hemodynamic stability during dialysis sessions. Therefore, besides nephrologists and diabetologists, many specialists such as cardiologists, physicians, nurses, clinical engineers, pharmacists, and nutritionists could be involved and contribute with their expertise to this Special Issue on “Clinical Management of End-Stage Renal Disease and Hemodialysis Patients with Diabetes”.

The present work aims to update clinicians by summarizing the remarkable progress made recently in the care of diabetic patients with ESRD.

Prof. Dr. Filippo Mariano
Guest Editor

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Keywords

diabetic nephropathy
end-stage renal disease
hemodialysis
SGLT2i
GLP1RA
DDP-4i
NOACs
peripheral vascular disease
hemodynamic instability
epidemiology

Published Papers (2 papers)

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Research

Jump to: Review

12 pages, 1882 KiB

Open AccessArticle

Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury

by Filippo Mariano, Consuelo De Biase, Zsuzsanna Hollo, Ilaria Deambrosis, Annalisa Davit, Alberto Mella, Daniela Bergamo, Stefano Maffei, Francesca Rumbolo, Alberto Papaleo, Maurizio Stella and Luigi Biancone

J. Clin. Med. 2021, 10(24), 5760; https://doi.org/10.3390/jcm10245760 - 9 Dec 2021

Cited by 9 | Viewed by 2171

Abstract

Background. The real impact of septic shock-associated acute kidney injury (AKI) on the long-term renal outcome is still debated, and little is known about AKI-burn patients. In a cohort of burn survivors treated by continuous renal replacement therapy (CRRT) and sorbent technology (CPFA-CRRT), we investigated the long-term outcome of glomerular and tubular function. Methods. Out of 211 burn patients undergoing CRRT from 2001 to 2017, 45 survived, 40 completed the clinical follow-up (cumulative observation period 4067 months, median 84 months, IR 44-173), and 30 were alive on 31 December 2020. Besides creatinine and urine albumin, in the 19 patients treated with CPFA-CRRT, we determined the normalized GFR by 99mTc-DTPA (NRI-GFR) and studied glomerular and tubular urine protein markers. Results. At the follow-up endpoint, the median plasma creatinine and urine albumin were 0.99 (0.72–1.19) and 0.0 mg/dL (0.0–0.0), respectively. NRI-GFR was 103.0 mL/min (93.4–115). Four patients were diabetic, and 22/30 presented at least one risk factor for chronic disease (hypertension, dyslipidemia, and overweight). Proteinuria decreased over time, from 0.47 g/day (0.42–0.52) at 6 months to 0.134 g/day (0.09–0.17) at follow-up endpoint. Proteinuria positively correlated with the peak of plasma creatinine (r 0.6953, p 0.006) and the number of CRRT days (r 0.5650, p 0.035) during AKI course, and negatively with NRI–GFR (r −0.5545, p 0.049). In seven patients, urine protein profile showed a significant increase of glomerular marker albumin and glomerular/tubular index. Conclusions. Burn patients who experienced septic shock and AKI treated with CRRT had a long-term expectation of preserved renal function. However, these patients were more predisposed to microalbuminuria, diabetes, and the presence of risk factors for intercurrent comorbidities and chronic renal disease. Full article

(This article belongs to the Special Issue Clinical Management of End-Stage Renal Disease and Hemodialysis Patients with Diabetes)

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Review

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16 pages, 845 KiB

Open AccessReview

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

by Giuseppe Cavallari and Elena Mancini

J. Clin. Med. 2022, 11(6), 1521; https://doi.org/10.3390/jcm11061521 - 10 Mar 2022

Cited by 3 | Viewed by 2358

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. Full article

(This article belongs to the Special Issue Clinical Management of End-Stage Renal Disease and Hemodialysis Patients with Diabetes)

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