Diabetes and Dialysis

Diabetes mellitus, usually called diabetes, is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. Insulin is a hormone that regulates the amount of sugar in your blood. Having a high blood sugar level can cause problems in many parts of your body.

How is diabetes connected to kidney failure?

With diabetes, the small blood vessels in the body are injured. With the blood vessels in the kidneys injured, your organs will not be able to clean your blood properly. Your body will then retain more water and salt than it should, which can result in weight gain and ankle swelling. Protein may also be found in your urine, something that doesn’t happen when you have healthy kidneys. Also, waste materials will build up in your blood.

Diabetes can also cause damage to the nerves in your body, which may result to difficulty emptying your bladder. When this happens, the pressure resulting from your full bladder can back up and injure the kidneys. At the same time, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria that contains high sugar level.

What are the signs of kidney disease in patients with diabetes?

  • Albumin/protein in the urine
  • High blood pressure
  • Ankle and leg swelling
  • Leg cramps
  • Going to the bathroom more often at night
  • High levels of BUN and creatinine in blood
  • Less need for insulin or antidiabetic medications
  • Morning sickness, nausea and vomiting
  • Weakness, paleness and anaemia
  • Itching

Which is better for patients with diabetes: haemodialysis or peritoneal dialysis?

There are advantages and disadvantages to both treatment modalities. You and your health care team must choose the treatment that best suits your lifestyle, taking into consideration comorbidities and medical history.

Advantages for the in-centre haemodialysis include frequent medical surveillance and smaller loss of protein from the dialysate. Disadvantages are higher risk of vascular access complications, risk of predialysis hyperkalaemia, and an increased incidence of hypotension during dialysis.

Peritoneal dialysis may offer better glycaemic control, especially if intraperitoneal insulin is used. It also offers better cardiovascular tolerance. The downside of this is that potassium problems of peritoneal dialysis are magnified. Examples include more episodes of increased intra-abdominal pressure complication such as gastroparesis. Also, peritoneal dialysis is hard to carry out for someone who has poor eyesight. Fine motor control requires the patient to be dialyzed in-centre if you do not have an assistant at home.

Diabetic Patients Need More Dialysis Than Non-Diabetic Patients

Diabetes affects every cell, tissue, and organ of the body. Diabetes patients who also have end-stage renal disease face a tougher challenge. In order to have better survival prospects, patients with diabetes need to achieve higher urea clearance rates than other patients. But with multisystem organ involvement, this may be difficult to achieve.

Patients with diabetes and autonomic neuropathy are at risk during kidney dialysis because of hypotension in the first hour of the treatment. A diseased cardiovascular and autonomic nervous system cannot adequately respond to intravascular volume changes that occur with ultrafiltration. Dialysis blood flow is frequently lowered to treat this hypotension along with administration of extra saline. Symptomatic hypotension sometimes leads to early termination of treatment, affecting the adequacy of dialysis and leaving the patient fluid-overloaded, thus further stressing the cardiovascular system. Peripheral vascular disease contributes to vascular access problems with subsequent inadequacy of dialysis.

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