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

Buades, Juan M.; Craver, Lourdes; Del Pino, Maria Dolores; Prieto-Velasco, Mario; Ruiz, Juan C.; Salgueira, Mercedes; de Sequera, Patricia; Vega, Nicanor

doi:10.3390/jcm10132943

Open AccessReview

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

by

Juan M. Buades

^1,2,*,†

,

Lourdes Craver

^3,†,

Maria Dolores Del Pino

^4,†,

Mario Prieto-Velasco

^5,†,

Juan C. Ruiz

^6,7,†

,

Mercedes Salgueira

^8,9,10,†,

Patricia de Sequera

^11,12,†

and

Nicanor Vega

^13,†

¹

Department of Nephrology, Hospital Universitario Son Llàtzer, Balearic Islands, 07198 Palma de Mallorca, Spain

²

Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain

³

Department of Nephrology, Hospital Universitario Arnau de Vilanova, 25198 Lleida, Spain

⁴

Department of Nephrology, Complejo Hospitalario Torrecárdenas de Almería, 04009 Almería, Spain

⁵

Department of Nephrology, Complejo Asistencial Universitario de Leon, 24001 León, Spain

⁶

Department of Nephrology, Valdecilla Hospital, University of Cantabria, 39008 Santander, Spain

⁷

Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain

⁸

Department of Nephrology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain

⁹

Biomedical Engineering Group, Medicine Department, University of Seville, 41092 Seville, Spain

¹⁰

Center for Biomedical Research Network in Bioengineering Biomaterials and Nanomedicina (CIBER-BBN), 28029 Madrid, Spain

¹¹

Department of Nephrology, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain

¹²

Medicine Department, Universidad Complutense de Madrid, 28031 Madrid, Spain

¹³

Department of Nephrology, Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain

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^*

Author to whom correspondence should be addressed.

^†

All the authors contributed equally to this work.

J. Clin. Med. 2021, 10(13), 2943; https://doi.org/10.3390/jcm10132943

Submission received: 23 May 2021 / Revised: 22 June 2021 / Accepted: 25 June 2021 / Published: 30 June 2021

(This article belongs to the Collection Facing the Future: New Perspectives in Diabetes and Kidney Disease)

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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.

Keywords: chronic kidney disease; diabetic kidney disease; hemodialysis; peritoneal dialysis; home hemodialysis; kidney transplant; kidney failure; kidney replacement therapy; comprehensive conservative care

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MDPI and ACS Style

Buades, J.M.; Craver, L.; Del Pino, M.D.; Prieto-Velasco, M.; Ruiz, J.C.; Salgueira, M.; de Sequera, P.; Vega, N. Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options? J. Clin. Med. 2021, 10, 2943. https://doi.org/10.3390/jcm10132943

AMA Style

Buades JM, Craver L, Del Pino MD, Prieto-Velasco M, Ruiz JC, Salgueira M, de Sequera P, Vega N. Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options? Journal of Clinical Medicine. 2021; 10(13):2943. https://doi.org/10.3390/jcm10132943

Chicago/Turabian Style

Buades, Juan M., Lourdes Craver, Maria Dolores Del Pino, Mario Prieto-Velasco, Juan C. Ruiz, Mercedes Salgueira, Patricia de Sequera, and Nicanor Vega. 2021. "Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options?" Journal of Clinical Medicine 10, no. 13: 2943. https://doi.org/10.3390/jcm10132943

APA Style

Buades, J. M., Craver, L., Del Pino, M. D., Prieto-Velasco, M., Ruiz, J. C., Salgueira, M., de Sequera, P., & Vega, N. (2021). Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options? Journal of Clinical Medicine, 10(13), 2943. https://doi.org/10.3390/jcm10132943

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

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