scholarly journals Pancreas before Kidney Transplant in Diabetic Patients with Uremia

2021 ◽  
Author(s):  
Bor-Uei Shyr ◽  
Bor-Shiuan Shyr ◽  
Shih-Chin Chen ◽  
Yi-Ming Shyr ◽  
Shin-E Wang
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Endocrine Function ◽  
Pancreas Transplant ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hba1c Levels ◽  
Pancreas Graft

Abstract Theoretically, pancreas before kidney transplant (PBK) could also be one of the options for those waiting for both pancreas and kidney grafts, but it has never been reported. This study is to clarify the justification and feasibility of PBK. There were 160 cases of pancreas transplant in this study, including 26 (16%) PBK. Rejection (3.8%) of pancreas graft was significantly lower in PBK group, followed by 16.7% in pancreas after kidney transplant (PAK), 29.8% in simultaneous pancreas and kidney transplant (SPK) and 37.0% in pancreas transplant alone (PTA). There was no chronic rejection in PBK and PAK groups. Fasting blood sugar and serum HbA1c levels after PBK were not significantly different from those by other subgroups. The serum C-peptide levels were significantly higher in PBK group than those by other subgroups. The 5-year pancreas graft survival was 100% for PBK and PAK, 97.0% for SPK and 77.9% for PTA. In conclusion, PBK could be a treatment option for patients with diabetes complicated by end-stage renal disease (ESRD) in terms of surgical risks, endocrine function, and immunological and graft survival outcomes. However, given the inferior patient survival outcome, PBK is still not recommended unless SPK and PAK is not available.

scholarly journals Mortality after amputation in dialysis patients is high but not modified by diabetes status

2019 ◽  
Vol 13 (6) ◽  
pp. 1077-1082 ◽  
Author(s):  
Marielle A Schroijen ◽  
Merel van Diepen ◽  
Jaap F Hamming ◽  
Friedo W Dekker ◽  
Olaf M Dekkers
Keyword(s):  
Mortality Risk ◽  
Interaction Analysis ◽  
Diabetic Patients ◽  
Comorbid Conditions ◽  
Dialysis Patients ◽  
Diabetes Status ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Incident Cases

Abstract Background Survival among dialysis patients with diabetes mellitus (DM) is inferior to survival of non-diabetic dialysis patients, probably due to the higher prevalence of diabetes-related comorbid conditions. One could hypothesize that these comorbid conditions also contribute to a decreased survival after amputation in diabetic patients compared with non-diabetic patients on dialysis. Methods Data were collected from the Netherlands Cooperative Study on the Adequacy of Dialysis, a multicentre, prospective cohort study in which new patients with end-stage renal disease were monitored until transplantation or death. Amputation rates (incident cases) were calculated in patients with and without DM. The primary endpoint was all-cause survival after first amputation during dialysis therapy in diabetic patients compared with non-diabetic dialysis patients with an amputation. This was formally assessed using interaction analysis (Poisson regression). Results During follow-up (mean duration 2.9 years), 50 of the 413 diabetic patients had a new amputation (12.1%), compared with 20 of 1553 non-diabetic patients (1.2%). Amputation rates/1000 person-years were 47.9 [95% confidence interval (CI) 36.3–63.2] and 4.1 (95% CI 2.7–6.4), respectively, for diabetic patients and non-diabetic patients. Amputation increased mortality risk more than 4-fold in patients without diabetes [hazard ratio (HR) 4.6 (95% CI 2.8–7.6)] as well as in patients with diabetes [HR 4.6 (95% CI 3.3–6.4)]. No formal interaction between diabetes and amputation was found (P = 0.12). Conclusions Amputation in dialysis patients is associated with a 4-fold increased mortality risk; this mortality risk was similar for diabetes and non-diabetes patients. Importantly, the risk for amputation is 10-fold higher in DM compared with non-diabetic dialysis patients.

Simultaneous pancreas-kidney transplant compared with kidney transplant in Type I diabetic patients with end-stage renal disease

2001 ◽  
Vol 33 (7-8) ◽  
pp. 3494-3495 ◽  
Author(s):  
R. Pérez ◽  
M.D. Navarro ◽  
D. del Castillo ◽  
R. Santamarı́a ◽  
J. Padillo ◽  
...  
Keyword(s):  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Diabetic Patients ◽  
Type I ◽  
Simultaneous Pancreas Kidney ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Association of HbA1C Variability and Renal Progression in Patients with Type 2 Diabetes with Chronic Kidney Disease Stages 3–4

2018 ◽  
Vol 19 (12) ◽  
pp. 4116 ◽  
Author(s):  
Mei-Yueh Lee ◽  
Jiun-Chi Huang ◽  
Szu-Chia Chen ◽  
Hsin-Ying Chiou ◽  
Pei-Yu Wu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lower Risk ◽  
Glycosylated Hemoglobin ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Cox Analysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hba1c Variability

Little is known about the predictive value of glycosylated hemoglobin (HbA1C) variability in patients with advanced chronic kidney disease (CKD). The aim of this study was to investigate whether HbA1C variability is associated with progression to end-stage renal disease in diabetic patients with stages 3–5 CKD, and whether different stages of CKD affect these associations. Three hundred and eighty-eight patients with diabetes and stages 3–5 CKD were enrolled in this longitudinal study. Intra-individual HbA1C variability was defined as the standard deviation (SD) of HbA1C, and the renal endpoint was defined as commencing dialysis. The results indicated that, during a median follow-up period of 3.5 years, 108 patients started dialysis. Adjusted Cox analysis showed an association between the highest tertile of HbA1C SD (tertile 3 vs. tertile 1) and a lower risk of the renal endpoint (hazard ratio = 0.175; 95% confidence interval = 0.059–0.518; p = 0.002) in the patients with an HbA1C level ≥ 7% and stages 3–4 CKD, but not in stage 5 CKD. Further subgroup analysis showed that the highest two tertiles of HbA1C SD were associated with a lower risk of the renal endpoint in the group with a decreasing trend of HbA1C. Our results demonstrated that greater HbA1C variability and a decreasing trend of HbA1C, which may be related to intensive diabetes control, was associated with a lower risk of progression to dialysis in the patients with stages 3–4 CKD and poor glycemic control (HbA1c ≥ 7%).

Peritoneal Dialysis Prescription for Diabetic Patients

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 76-78 ◽  
Author(s):  
Qiang Yao ◽  
Bengt Lindholm ◽  
Olof Heimbürger
Keyword(s):  
Peritoneal Dialysis ◽  
Diabetic Patients ◽  
High Morbidity ◽  
Advantages And Disadvantages ◽  
Patients With Diabetes ◽  
Severe Comorbidity ◽  
Systemic Problems ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

The number of end-stage renal disease (ESRD) patients with diabetes mellitus has increased dramatically during the past few years and, in many countries, diabetes has become the most important cause of ESRD in patients admitted to dialysis. Furthermore, compared to nondiabetic patients, diabetic patients continue to suffer from more frequent and severe comorbidity and complications, including cardiovascular disease, poor fluid balance, worse quality of life, as well as high morbidity and mortality after initiation of dialysis. These systemic problems in diabetic patients should influence the dialysis prescription. In addition, the structure and transport properties of the peritoneal membrane may deteriorate as a consequence of diabetes. Thus, both the systemic and the peritoneal consequences of diabetes influence the dialysis prescription in diabetic patients. In this brief review, we discuss the care of diabetic ESRD patients on peritoneal dialysis — which, compared with hemodialysis, has both advantages and disadvantages in this group of patients — focusing on the special needs for intense and integrated care involving individualized dialysis prescription as well as care of diabetic complications and comorbidity in this diseased patient group.

Alexithymic Characteristics of Bulimia Nervosa in Diabetes Mellitus with End-Stage Renal Disease

1997 ◽  
Vol 81 (2) ◽  
pp. 627-633 ◽  
Author(s):  
Isao Fukunishi
Keyword(s):  
Diabetes Mellitus ◽  
Renal Failure ◽  
Bulimia Nervosa ◽  
Prevalence Rate ◽  
Diabetic Patients ◽  
Related Factors ◽  
End Stage Renal Failure ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage

This study examined the clinical characteristics including stress-related factors of eating disorders in a sample of 312 diabetic patients with end-stage renal failure. The prevalence rate of bulimia nervosa was 5.1% (16 of 312 patients). The 16 patients with bulimia nervosa were 8 men and 8 women over 58 years old. Looking at the subjects by cause of end-stage renal failure, those with diabetes mellitus exhibited significantly higher prevalence rate of bulimia nervosa than two nondiabetic groups (diabetes 10%; nephritis 1.6%; others 1.9%). As for the association of bulimia nervosa and stress-related factors, end-stage renal failure patients with diabetes who exhibited bulimia nervosa showed significantly higher scores on a measure of alexithymia. These results suggest that, when liaison psychiatrists see diabetic patients with end-stage renal failure who exhibit bulimia nervosa, they should pay close attention to stress-related symptoms including alexithymia.

scholarly journals Worldwide epidemiology of diabetes-related end-stage renal disease, 2000–2015

2020 ◽  
Author(s):  
Hui-Teng Cheng ◽  
Xiaoqi Xu ◽  
Paik Seong Lim ◽  
Kuan-Yu Hung
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Annual Incidence ◽  
Western Pacific ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
The Western Pacific

Objective <p>The annual risk among diabetic patients to reach end-stage renal disease (ESRD) is largely unknown worldwide. This study aimed to compare the incidence of diabetes-related ESRD by creating a global atlas during 2000–2015.</p> <p>Research Design and Methods</p> <p>The annual incidence of ESRD among diabetic patients was calculated as the quotient of the number of incident ESRD patients with diabetes divided by the total number of patients with diabetes after subtracting the number with existing ESRD. The estimated ESRD prevalence and annual incidence were validated using the data provided by Fresenius Medical Care, Germany, and previously reported data, respectively.</p> <p>Results</p> <p>Data were obtained from 142 countries, covering 97·3% of the world population. The global percentage of the prevalent ESRD patients with DM increased from 19·0% in 2000 to 29·7% in 2015 worldwide, while the percentage of incident ESRD patients due to DM increased from 22·1% to 31·3%. The global annual incidence of ESRD among DM patients increased from 375·8 to 1016·0/million with DM during 2000–2015. The highest average rates were observed in the Western Pacific Region. Comparatively, the rates of incident ESRD among European DM patients ranged from half (309·2 vs 544·6) to a third (419·4 vs 1245·2) of the rates of the Western Pacific population during 2000–2015.</p> <p>Conclusions </p> <p>Great and nonrandom geographic variation in the annual rates among diabetic patients to reach ESRD suggests that distinct healthcare, environmental, and/or genetic factors contribute to the progression of diabetic kidney disease. Measures to prevent and treat DM-related ESRD require better patient susceptibility stratification.</p>

Abstract 370: Contrast-Induced Nephropathy and Long-Term Outcomes in Patients With Diabetes Undergoing Coronary and Peripheral Angiography and Intervention

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Dennis A Hopkinson ◽  
Samuel P Powell ◽  
Raveen Chawla ◽  
Wendy Bottinor ◽  
Jeremy S Turlington ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Long Term Outcomes ◽  
Peripheral Angiography ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage

Background: Patients with diabetes may be at increased risk of contrast-induced nephropathy (CIN) when undergoing coronary and/or peripheral angiography or intervention but there is little data on long-term outcomes. We examined the relationship between diabetes, CIN and long-term outcomes in patients undergoing coronary and/or peripheral angiography and intervention. Methods and Results: We studied 4070 consecutive, predominantly (98%) male patients undergoing coronary and peripheral angiography and intervention and assessed the association between diabetes, CIN and long-term outcomes including renal dysfunction at 3 months, the need for dialysis and mortality. The mean age of the patients was 66.6 years. Approximately two fifths of the patients (n=1671, 41.05%) were diabetic. Patients with diabetes were the same age but had higher baseline creatinine compared to the patients without diabetes. CIN occurred in 70 (4.19%) diabetic patients and in 64 (2.67%) patients without diabetes at 72 hours after the procedure (odds ratio [OR] 1.59; 95% confidence interval [CI] 1.13 - 2.25; P=0.008). At 3 months, renal dysfunction was seen in 179 (10.71%) diabetic patients versus 174 (7.25%) of the non-diabetic group (OR 1.53, CI 1.23 - 1.91; P=0.0001). After a follow-up of 5 years, 31 (1.86 %) patients with diabetes had developed end-stage renal disease and were started on dialysis versus 13 (0.54 %) of the non-diabetic group (OR 3.47, CI 1.81 - 6.65; P<0.0001). 478 (28.61 %) patients of the diabetic group had died versus 479 (19.97 %) of the non-diabetic group (OR 1.61, CI 1.39 - 1.86; P<0.0001). On multivariate analysis, after adjustment for age, comorbidities, medical therapy and baseline creatinine, the presence of diabetes was significantly associated with CIN (OR 1.50, CI 1.06 - 2.43: p=0.02) and was significantly associated with the incidence of end stage renal disease requiring dialysis (OR 3.64, CI 2.07-10.04; P<0.0001) and with mortality at 5 years (OR 1.58, CI 1.42-2.03, P<0.0001). Conclusion: In this cohort of patients undergoing coronary and/or peripheral angiography and intervention diabetes was associated with CIN, with end-stage renal disease and the need for hemodialysis and was associated with an increased mortality.

scholarly journals Worldwide epidemiology of diabetes-related end-stage renal disease, 2000–2015

2020 ◽  
Author(s):  
Hui-Teng Cheng ◽  
Xiaoqi Xu ◽  
Paik Seong Lim ◽  
Kuan-Yu Hung
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Annual Incidence ◽  
Western Pacific ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
The Western Pacific

Objective <p>The annual risk among diabetic patients to reach end-stage renal disease (ESRD) is largely unknown worldwide. This study aimed to compare the incidence of diabetes-related ESRD by creating a global atlas during 2000–2015.</p> <p>Research Design and Methods</p> <p>The annual incidence of ESRD among diabetic patients was calculated as the quotient of the number of incident ESRD patients with diabetes divided by the total number of patients with diabetes after subtracting the number with existing ESRD. The estimated ESRD prevalence and annual incidence were validated using the data provided by Fresenius Medical Care, Germany, and previously reported data, respectively.</p> <p>Results</p> <p>Data were obtained from 142 countries, covering 97·3% of the world population. The global percentage of the prevalent ESRD patients with DM increased from 19·0% in 2000 to 29·7% in 2015 worldwide, while the percentage of incident ESRD patients due to DM increased from 22·1% to 31·3%. The global annual incidence of ESRD among DM patients increased from 375·8 to 1016·0/million with DM during 2000–2015. The highest average rates were observed in the Western Pacific Region. Comparatively, the rates of incident ESRD among European DM patients ranged from half (309·2 vs 544·6) to a third (419·4 vs 1245·2) of the rates of the Western Pacific population during 2000–2015.</p> <p>Conclusions </p> <p>Great and nonrandom geographic variation in the annual rates among diabetic patients to reach ESRD suggests that distinct healthcare, environmental, and/or genetic factors contribute to the progression of diabetic kidney disease. Measures to prevent and treat DM-related ESRD require better patient susceptibility stratification.</p>

Peritoneal Dialysis in Patients with Diabetes: Are the Benefits Greater than the Disadvantages?

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 190-195 ◽  
Author(s):  
Satoru Kuriyama
Keyword(s):  
Diabetic Nephropathy ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Diabetic Patients ◽  
Dialysis Modality ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Selection Of

Diabetic nephropathy has been increasing in prevalence in recent years, and it is now the dominant cause of end-stage renal disease (ESRD) worldwide. Because diabetes is frequently associated with multiple complications, nephrologists must be alert to the selection of dialysis modality so as to reduce the accompanying risks. The present review addresses whether the benefits of peritoneal dialysis are greater than its disadvantages in diabetic patients. The answer is quite positive: for most diabetic patients, peritoneal dialysis offers multiple benefits.

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