The European Association for the Study of Diabetes

Abstract

At the meeting of the European Association for the Study of Diabetes (EASD) in Munich, Germany, on 5–9 September 2004, a number of important topics were addressed related to the causes and complications of diabetes. Norbert Lameire (Gent, Belgium) discussed the concept of “integrated renal care” of persons with end-stage renal disease (ESRD), noting the need for nephrology referral long before dialysis is required. At the time of referral to his unit, the mean creatinine clearance is 29 ml/min and few patients have good glucose or blood pressure control. He suggested calculation of creatinine clearance from serum creatinine and patient age and body size measurements {e.g., Cockcroft-Gault equation: (140 − age) × weight/([Cr] × 72) or Modification of Diet in Renal Disease Study Group equation: 170 × [Cr]−0.999 × age−0.176 × sex × race × [BUN]−0.170 × [albumin]0.318}, with referral when the glomerular filtration rate (GFR) is <40–50 ml/min. When renal replacement treatment is required, he suggested that peritoneal dialysis, hemodialysis, and transplantation should be seen as all being components of care to be utilized when appropriate for the individual patient (1). Thus, with the ultimate plan being to “transplant when you can,” there is evidence of better survival during the initial 2 years of ESRD with peritoneal dialysis. Subsequent survival may improve with hemodialysis, so that after 10 years hemodialysis provides either better (2) or equivalent (3) outcome. A synthesis is the recommendation that peritoneal dialysis be the initial modality, with subsequent shift to hemodialysis, an approach that may be particularly useful for persons with diabetes, who may have greater peritoneal membrane vascular surface area than those without diabetes. Over several years of treatment with peritoneal dialysis, the ultrafiltration capacity of the peritoneal membrane decreases from peritoneal inflammation as well as from frank infection, …