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Review: The epidemic of diabetic renal disease — the practical challenges for renal replacement programmes

Department of Nephrology, North Staffordshire Hospitals Trust, Princes Road, Hartshill, Stoke-on-Trent, ST4 7LN, UK, SimonDavies1{at}compuserve.com

Diabetic patients represent the largest group requiring renal replacement therapy in the developed nations, although take-on rates in the UK still lag behind other countries. As a group, diabetic patients present specific challenges to those providing renal replacement, including disproportionate late referral and under-recognition of renal insufficiency, multiple co-morbidity, and issues relating to choice of dialysis modality and when dialysis should be started. This review explores these issues and argues that it is by concentrating on the pre-dialysis phase of care that clinicians are most likely to achieve a more favourable clinical outcome. In addition to the benefits of good blood pressure and diabetic control, time is needed to inform and educate the patient prior to dialysis, and to evaluate co-morbidity if transplantation is to be considered. To achieve this, patients require nephrological supervision in the context of a well-resourced, multidisciplinary pre-dialysis programme, commencing a minimum of one year before starting renal replacement therapy.

Key Words: co-morbidity • multi-professional care • patient education • dialysis modality • late referral.

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The British Journal of Diabetes & Vascular Disease, Vol. 2, No. 2, 86-89 (2002)
DOI: 10.1177/14746514020020020401


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This Article Abstract 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 Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Davies, S. J Search for Related Content Social Bookmarking                         What's this?