MO632FIRST PLACE IN MORTALITY DUE TO DIABETES IN EUROPE BRINGS TO ALERT OF MULTIDISCIPLINARY TREATMENT IN ALBANIA. ROLE OF NEPHROLOGISTS

Background and Aims Diabetes mellitus was prevalent in nearly 0.8 % of the adult population and assent in our modest hemodialytic population in 1990. Changing of lifestyle and nutrition, increase in longevity, aging population, and stress have brought to increase of this morbid condition. Nowadays, with a galloping rise, we have a prevalence of 11,1 % of DM in the adult population and nearly 22% of hemodialysis patients whose primary diagnosis is diabetes. Despite this, data of EUROSTAT put us in the first place for mortality due to diabetes. It's time to act! Method We analyzed the number of diabetic patients in Albania second the IDF data and the number of diabetic nephropathy patients hospitalized during this decade in our Departement of Nephrology according the Statistical Department of UHC "Mother Theresa". Results In 2010 there were 4.5% diabetics in the adult population in Albania and in 2019 there were 9%, so doubling of numbers. Diabetic nephropathy is increasing too and now is our everyday clinical practice challenge, in 2010 there were 54 patients hospitalized for DN and its complications and in 2019 this number increased to 164 patients. Diabetics on hemodialysis are now more and more present with their problems and difficulties that need not only nephrologists but a multidisciplinary approach. Diabetic nephropathy in 2011 had only 11,3% of the hemodialytic pie and now is reaching 17,2% of the primary cause of ESRD in our hemodialytic population, regarding ERA EDTA registry, but our 2020 numbers rise to 22%. We are below the European and North American data but in incident patients it is becoming the second predominant cause of renal failure, after the hypertensive nephrosclerosis, reaching 25%-27%. Mortality in this population is a crucial point, we stand first in Europe with 110 deaths/ million inhabitants despite the reimbursement range is three-fold compared to 10 years ago An increasing number is translated into increased problems especially in vascular access, cardiovascular problems, diabetic foot problems, glycemic control, etc. Conclusion Nephrology Units and Hemodialysis Units too are being invaded by diabetics Caring about the glycemic levels, type of hypoglycemia drugs, time and dosage, eating or not during the hemodialysis session, are every session challenges. Cardiovascular problems with frequent hypotensions, coronary heart disease, and cardiac heart failure are other difficult to manage fields. But the most important and continuous care is that of vascular access, the "Achille's Heel" of our patients. Results from our studies reveal diabetes like the second cause of arteriovenous fistulas failure, after the age of patients so we are reinforcing the whole medical chain for referring patients in the fourth stage of CKD for the creation of permanent vascular access, especially diabetics.