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DIABETES.Pdf The Diabetic Patient and Chronic Kidney Disease A Guide to Clinical Practice All rights are reserved by the author and publisher, including the rights of reprinting, reproduction in any form and translation. No part of this book may be reproduced, stored in a retrieval system or transmitted, in any form or by means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. First edition: September 2011 European Dialysis and Transplant Nurses Association/ European Renal Care Association (EDTNA/ERCA) Pilatusstrase 35, Postfach 3052, 6002 Luzern, Switzerland www.edtnaerca.org ISBN: 978-84-615-0906-5 D.L.: M-20964-2011 Layout, Binding and Printing: Imprenta Tomás Hermanos Río Manzanares, 42-44 · E28970 Humanes de Madrid Madrid - Spain www.tomashermanos.com 5 Acknowledgements The Diabetic Patient and Chronic Kidney Disease 6 Acknowledgements This book was an initiative of EDTNA/ERCA with the intention to follow the series of books: “Guide to Clinical Practice”. The idea is to cover all areas of renal care to offer guides for integrated care for all patients with renal disease. This book has been divided into two different parts. The fi rst one focused on scientifi c content with the collaboration of experts in Diabetes and Diabetic Nephropathy. The second section concentrates on clinical practice. It has not been easy to compile all the information/input received regarding the important and major disease of Diabetes and its interaction with Chronic Kidney Disease. For that reason, the EDTNA/ERCA would like to recognize all those who contributed to the consolidation of this publication. Thank you to the authors of the chapters of this book. Without your knowledge and effort it would not have been possible. Editors María Cruz Casal, RN, Nephrology Department, University Hospital 12 de Octubre, Madrid, Spain Jitka Pancirova, RN, EDTNA/ERCA Executive Director and Immediate Past President, Prague, Czech Republic Acknowledgements 7 Reviewers The EDTNA/ERCA would like to thank the following health care professionals for dedicating their time in reviewing the chapters of this book. They were a key element in fi nalizing chapter content, layout and accuracy for this book. María Cruz Casal, RN, University Hospital 12 de Octubre, Madrid, Spain Enrique Morales, Nephrologist, University Hospital 12 de Octubre, Madrid, Spain Eduardo Gutiérrez, Nephrologist, University Hospital 12 de Octubre, Madrid, Spain Dirk Struijk, MD, PhD, Dianet, Academic Medical Centre, University of Amsterdam, the Netherlands Aase Riemann, RN, Bc, Consultant Nephrology and Geriatrics, Amsterdam, the Netherlands Angela Henson, RN, MN, Grad Dip Nephrology, Princess Alexandra Hospital, Brisbane, Australia The EDTNA/ERCA and especially the editors of this book would like to thank Nichole LaPeer for her contribution in proof- reading and translations of these texts. Nichole is a native English speaker with a degree in Spanish and Linguistics from UCLA and a certifi cate in General Translation from International House, Barcelona. 9 Table of Contents The Diabetic Patient and Chronic Kidney Disease 10 Preface .............................................................................................................. 15 Jitka Pancírová, RN, EDTNA/ERCA Immediate Past President and Executive Director SECTION I - DIABETES AND THE KIDNEY 1. Epidemiology Of Diabetes .......................................................... 19 Enrique Morales, Nephrologist, University Hospital 12 de Octubre, Madrid, Spain 2. Obesity, Diabetes and the Kidney ...................................... 33 Manuel Praga, Nephrologist, University Hospital 12 de Octubre, Madrid, Spain 3. Pathogenesis and Risk Factors of Diabetic Nephropathy ................................................................................................ 49 Ioanna Makriniotou, Nephrologist, General Hospital of Nikea, Nikea, Greece 4. Treatment of Diabetic Nephropathy ................................. 63 Enrique Morales, Nephrologist, University Hospital 12 de Octubre, Madrid, Spain Table of Contents 11 5. Oral Anti-Diabetics and Insulin in Patients with Diabetic Nephropathy ....................................................................... 79 María Ángeles Valero, MD, Endocronology and Nutrition, University Hospital 12 de Octubre, Madrid, Spain 6. Diabetes Mellitus and Renal Transplantation .... 107 Eduardo Gutiérrez, Nephrologist, University Hospital 12 de Octubre, Madrid, Spain 7. Diabetes Mellitus and Pancreas-Renal Transplantation ..................................................................................... 123 Eduardo Gutiérrez, Nephrologist, University Hospital 12 de Octubre, Madrid, Spain SECTION II - CARING FOR DIABETICS WITH CHRONIC KIDNEY DISEASE 1. Assessment of Glycaemic Control in the Dialysis Population ................................................................................................... 139 Lina Schwarz, RN, BN, MHA, Nephrology Department, Soroka University Medical Center, Beer-Sheva, Israel Nurit Cohen, RN, BN, Master of Public Health (MPH), Nephrology Department, Soroka University Medical Center, Beer-Sheva, Israel The Diabetic Patient and Chronic Kidney Disease 12 2. Chronic Complications in Diabetic Patients ....... 151 José Luis Cobo Sánchez, RN, University Hospital Marqués de Valdecilla, Santander, Spain Raquel Menezo Viadero, RN, University Hospital Marqués de Valdecilla, Santander, Spain 3. Acute Complications in Diabetics Patients .......... 167 José Luis Cobo Sánchez, RN, University Hospital Marqués de Valdecilla, Santander, Spain Raquel Menezo Viadero, RN, University Hospital Marqués de Valdecilla, Santander, Spain 4. Haemodialysis and the Diabetic Patient .................. 181 Lyn Allen, RN, Derby Hospitals NHS Foundations Trust, Derby, United Kingdom Catherine Fielding,RN, Derby Hospitals NHS Foundations Trust, Derby, United Kingdom 5. Peritoneal Dialysis in Patients with Diabetic Nephropathy ............................................................................................. 195 Lyn Allen, RN, Derby Hospitals NHS Foundations Trust, Derby, United Kingdom Nicola Beech, RN, Derby Hospitals NHS Foundations Trust, Derby, United Kingdom Table of Contents 13 6. Diabetes Treatment and CKD ................................................ 209 José Luis Cobo Sánchez, RN, University Hospital Marqués de Valdecilla, Santander, Spain Raquel Menezo Viadero, RN, University Hospital Marqués de Valdecilla, Santander, Spain 7. Diet for Patients with Diabetes and CKD ................. 233 Raquel Menezo Viadero, RN, University Hospital Marqués de Valdecilla, Santander, Spain José Luis Cobo Sánchez, RN, University Hospital Marqués de Valdecilla, Santander, Spain 8. Health Education in Diabetic and CKD Patients ........ 245 Raquel Menezo Viadero, RN, University Hospital Marqués de Valdecilla, Santander, Spain José Luis Cobo Sánchez, RN, University Hospital Marqués de Valdecilla, Santander, Spain 9. De Novo Diabetes Mellitus in Post-transplant ............ 257 Isabel Delgado, RN, University Hospital 12 de Octubre, Madrid, Spain Eduardo Gutiérrez, Nephrologist, University Hospital 12 de Octubre, Madrid, Spain 15 Preface The Diabetic Patient and Chronic Kidney Disease 16 The EDTNA/ERCA promotes quality in renal care through professional education, implementation of clinical standards and research in renal care throughout Europe. The Association has published various renal specifi c handbooks (Peritoneal Dialysis, Kidney Transplantation), however there is a need to implement a broader focus, because Chronic Kidney Disease (CKD) can have a number of causes and appears as a wide range of symptoms requiring medical interventions. Diabetes is an increasingly important cause of renal failure and has now become the most common cause of end stage renal disease which requires renal replacement therapy. The number of people with diabetes is increasing due to population growth, aging, urbanization, and increasing prevalence of obesity and physical inactivity.1 Diabetes is challenging to manage in patients who have end-stage renal disease, as both uraemia and dialysis can complicate glycaemic control by affecting the secretion, clearance, and peripheral tissue sensitivity of insulin.2 All the facts mentioned above demonstrate that multidisci- plinary management is the cornerstone in the successful treatment of CKD patients with diabetes. We do hope this handbook will guide you in your daily clinical practice as the EDTNA/ERCA has the responsibility to continually strive to improve the quality of nephrology practice and to ensure the highest level of professional competence among its interna- tional members. References 1. Wild S, Roglic G,Green A, Global Prevalence of Diabetes –Estimates for the year 2000 and projections for 2030. Diabetes Care, volume 27, number 5, May 2004. 2. Shrishrimal K,Hart P,Michota F, Cleveland Clinic Journal of Medi- cine, volume 76 number11, November 2009. SECTION I - DIABETES AND THE KIDNEY 19 Epidemiology of Diabetes The Diabetic Patient and Chronic Kidney Disease 20 Learning outcomes • Knowledge of the current world situation of diabetic nephropathy • Knowledge of the predictors and progression of diabetic nephropathy INTRODUCTION Today, DM is one of the greatest social and health problems in the world. It is prevalent in 2-6% of the general population and increases with age, reaching double in those over 65. Recently, there has been a signifi cant increase in the number of patients with DM, especially type 2
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