Management of diabetes in the dialysis patient
Lyn Allen, Clinical Facilitator, Royal Derby Hospital
Diabetes mellitus is one of the major causes of CKD ; these patients have a higher
incidence of co-morbidities, particularly cardiovascular disease, tend to be older, and
have an increased risk of hospitalisation, all which may have an effect when patients
commence renal replacement therapy.
Whilst the complications of diabetes in the context of haemodialysis is complex, it is
thought that good glycaemic control and management of these complications, along
with early detection, leads to the best possible outcomes. Management of the
diabetes and haemodialysis treatment as one entity, rather than 2 separate issues is
recommended, forging better links between renal and diabetes specialist teams, so
that the patient receives as near as possible seamless care.
Minimising the impact of the disease on the patient’s lifestyle is also important, which
renal nurses being taught to monitor patients for the complications of diabetes whilst
the patient is receiving dialysis, will minimise the number of additional hospital visits
that patients have to attend.
Peritoneal dialysis is associated with negative factors for patients with diabetes:
continuous glucose absorption from glucose containing PD solutions may lead to
hyperglycaemia, obesity, hyperlipidaemia, and increased peritoneal permeability and
fibrosis. Early initiation of non-glucose solutions has been proposed to slow the
progression of some of these complications
Diabetic patients newly commenced on PD must regularly assess blood glucose
levels, and have the integrated support from renal and diabetic teams to maximise
the potential of this treatment.