Current thinking on the management of the uremic diabetic.

Abstract

BOUT HALF of all type-1 diabetics, and an undefined but lesser proportion of type-II diabetics, will develop chronic renal failure (CRF). Diabetics constitute about one-fourth of end-stage renal disease patients in the United States, and a lesser but steadily increasing proportion (7.3% in 1981) in Europe.’ In general it has been found that diabetics suffer inordinately high morbidity and mortality compared to non-diabetic CRF patients. Data from the European Dialysis and Transplant Association Registry found only 70% one-year, and 28% five-year survival of diabetic CRF patients, roughly equivalent to the survival of nondiabetics 20 to 30 years older. The costs in human terms are enormous, and are reflected in dollar expense as well: we examined the first-year costs of transplanting 30 type-1 diabetics at our center and found that hospital charges were one-third higher for diabetics compared to a group of non-diabetic recipients.2 We will discuss aspects of treating the diabetic with advanced nephropathy that we feel are of importance in optimizing survival and rehabilitation. It is our strongly held opinion that effective application of currently available modalities offers much more to the diabetic patient than past statistics might indicate.