Dialysis Treatment Takes Toll on Diabetic Foot Care

For people with diabetes, kidney problems are usually picked up during a check-up by their doctor. Occasionally, a person can have type 2 diabetes without knowing it. This means their unchecked high blood sugar levels may be slowly damaging their kidneys.

“Dialysis is a miserable existence. It basically keeps you alive while you’re waiting for the best treatment, and the best treatment is a kidney transplant. The best treatment of all is prevention, but once you get to this stage, the best treatment is a kidney transplant. When you’re on dialysis, this takes over your life, and you may forget, because you’ve got no sensory symptoms, that you’ve got high-risk feet,” Andrew Boulton, MD, professor of medicine at the University of Manchester, UK, said during a presentation in March at the Diabetic Foot Global Conference (DFCon) in Los Angeles.

In addition, the increased transport of small molecules and proteins by the peritoneal membrane in diabetic patients adds the further problems of ultrafiltration deficit and malnutrition. The present article reviews pertinent evidence toward establishing the best strategy for the care of diabetic PD patients. With better glycemic control, improved nutrition, improved fluid balance, and optimal preservation of residual renal function, there is hope for improving the survival of diabetic PD patients.

As kidney disease progresses, a person’s appetite usually falls and blood sugar levels frequently become lower. It is not unusual that a person with diabetes may need to reduce the dosing of diabetes medicines to prevent excessively low glucose levels.

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Treatment Targets for Diabetic Patients on Peritoneal Dialysis

Diabetic patients are often affected by comorbid conditions that influence clinical outcome. Taking care of diabetic peritoneal dialysis (PD) patients is a challenge for nephrologists, not only because these patients have more complications and comorbidities, but also because of their difficulties in maintaining glycemic control with the use of current glucose-containing dialysis solutions.

Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases. Even when diabetes is controlled, the disease can lead to CKD and kidney failure. Most people with diabetes do not develop CKD that is severe enough to progress to kidney failure. Nearly 24 million people in the United States have diabetes,  and nearly 180,000 people are living with kidney failure as a result of diabetes. People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor. Most U.S. citizens who develop kidney failure are eligible for federally funded care. In 2005, care for patients with kidney failure cost the United States nearly $32 billion.

Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in many countries. Compared with nondiabetic patients, patients with diabetes generally have poorer survival because of a higher incidence of complications and comorbidities. Strategies for managing diabetic patients on peritoneal dialysis (PD) include proper control of glycemia, ultrafiltration, blood pressure, and metabolic status. In addition, prevention of cardiovascular complications, nutrition optimization, and preservation of residual renal function (RRF) are also important.

Unfortunately, these interventions do not always prevent kidney failure, and approximately 40% of people on dialysis have diabetes as the cause. If a person with diabetes has kidney disease requiring dialysis, the very best option is to get a kidney transplant. However, since getting a transplant usually takes several years and not everyone is able to get one, most people will need to decide between hemodialysis and peritoneal dialysis (PD). In addition to the type of dialysis, a person will choose whether to have dialysis in a dialysis center or perform dialysis at home.

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Diabetic Kidney Disease: Preventing Dialysis and Transplantation

Diabetic nephropathy is characterized by proteinuria and progressive kidney failure. Since the late 1990s, the occurrence of diabetic nephropathy has been steadily increasing; this condition is now the dominant cause of end-stage renal disease (ESRD) in many countries. The increasing prevalence of diabetic nephropathy is primarily attributable to the growing numbers of people who have type 2 diabetes mellitus (1).

Type 2 diabetic patients have a cardiovascular risk equivalent to nondiabetic individuals with a previous acute myocardial infarction.2 More importantly and often poorly appreciated, diabetic patients with early diabetic nephropathy (proteinuria or a minimally elevated serum creatinine >1.5 mg/dl) have an even greater cardiovascular risk.3 The degree of proteinuria correlates with this risk so that patients with macroalbuminuria have an even higher risk for coronary events than those with microalbuminuria. Abnormalities in vitamin D, parathyroid hormone, and calcium metabolism in patients with even moderate kidney failure lead to vascular and particularly coronary calcification,4 and this surely contributes to the high incidence of cardiovascular events. Once a patient reaches ESRD, the average survival on dialysis in the United States is 4–5 years, with death generally resulting from cardiovascular events or infection.

In the late 1970s, dialysis for patients with diabetes, who frequently have advanced cardiovascular complications, could provide only a limited benefit because of technical problems and insufficient options for medical treatment. As a result, patient survival at that time was poor. However, improvements in medical technologies and medicines, advances in the treatment of coronary artery disease and in critical care medicine, and introduction of earlier initiation of renal replacement therapy have combined to improve outcomes, with the result that dialysis for diabetic patients is now a widely accepted standard clinical practice.

The course of diabetic nephropathy is similar in type 1 and type 2 diabetes, although the diagnosis of type 2 diabetes is frequently delayed because of its insidious nature, giving the appearance of an earlier onset of nephropathy in type 2 diabetes. Microalbuminuria predicts the progression to diabetic nephropathy in 80% of untreated patients with type 1 diabetes and is rarely seen when patients have been diagnosed <5 years. Macroalbuminuria generally develops within 10 years, followed by a progressive rise in serum creatinine, eventually leading to ESRD requiring dialysis or transplantation. In contrast, microalbuminuria is commonly seen in patients with type 2 diabetes at the time of diabetes diagnosis or shortly thereafter and signifies vascular endothelial injury and increased cardiovascular risk.6 It is considered more a feature of the insulin resistance syndrome,7 and only 20–40% of these patients will progress to macroalbuminuria and kidney failure. The diagnosis of type 2 diabetes at an older age also leaves less time for ESRD to develop.

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Diabetic Kidney Disease Linked to Reduced Mitochondrial Function

Diabetic kidney disease is the leading cause of end-stage renal disease, but few biomarkers of this condition are available, wrote Kumar Sharma, MD, Director of the Center for Renal Translational Medicine at University of California San Diego (UCSD), and colleagues reported online ahead of print in the Journal of the American Society of Nephrology.

Dr. Sharma's team sought to identify such biomarkers by using gas chromatography-mass spectrometry to quantify 94 urine metabolites in three screening and validation cohorts:

Patients with diabetes mellitus and CKD (DM+CKD)

Patients with diabetes mellitus but not CKD (DM–CKD)

Healthy controls

Compared with levels in healthy controls, 13 metabolites were significantly reduced in the DM+CKD group, and 12 of the 13 metabolites remained significant when compared with the DM–CKD group. Analysis of bioinformatics data indicated that 12 of the 13 differently expressed metabolites are linked with mitochondrial metabolism and suggested suppression of mitochondrial activity in persons with DM+CKD.

“This work provides strong evidence that reduced mitochondrial function is a dominant feature of human diabetic kidney disease,” Dr. Sharma said in a UCSD statement.

The researchers found that a specific cellular pathway likely plays a key role to reduce mitochondrial function and content, meaning that new treatments that restore and increase mitochondrial function and content could ameliorate or even arrest CKD.

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Many Diabetes Patients Feel Pill Burden

Prescribing fixed-dose combinations of diabetes medications may reduce the pill burden many patients feel, according to new research published in Diabetes Care.
German researchers surveyed more than 3,800 patients with type 2 diabetes (more than 6 years) and 600 physicians about medication regimens. The vast majority of providers agreed that multiple pills made it harder for diabetes patients to adhere to treatment.

Most patients were taking 3 to 6 total pills daily. Seniors, half of whom took more than 6 tablets daily, felt particularly burdened, because many required assistance with taking their medications.

Most patients identified their medication by appearance, such as by the pill’s shape, size, and color. Two-thirds agreed that using the right medication becomes harder when its appearance changes, for example, because of a product switch. Half of the patients worried they would forget to take their pills or take the wrong kind or dose.
Physicians were well aware of the problems, and many opted to use fixed-dose combinations of medication to reduce the pill burden.

What Is Immunotherapy

Immunotherapy is a biotherapy which is designed by our doctors to treat the immune system damage. More than 95% of kidney diseases are related to immune system disorder, such as IgA Nephropathy, Lupus Nephritis, Diabetic Nephropathy etc.

Immune kidney disease is easy to relapse, because the current treatment usually focuses om the symptoms and complications of kidney damage, which fails to control the immune system disorder. Thereby, once patients have cold, bleeding or fever etc, their immune system disorder will flare up, which causes kidney damages come back.

Immunotherapy can rebuild a new immune system and uses the immune system to fight against the kidney disease, which can prevent the relapse of kidney damage from the root. To get details of immunotherapy, you are suggested to read the six steps of immunotherapy.

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Further Data on Diabetic Retinopathy Drug Requested

Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). Prevention and treatment involve a healthy diet, physical exercise, not using tobacco and being a normal body weight.

Eli Lilly and Company has received an approvable letter from the FDA requesting additional supporting data for its new drug application for ruboxistaurin mesylate (proposed trade name: Arxxant), Lilly's investigational oral therapy for diabetic retinopathy.

The company plans to meet with the FDA to determine whether a new study is required to meet the request or if data from an ongoing study will suffice.

“We will be working closely with the FDA to address issues outlined in the approvable letter and to define the pathway forward,” said Timothy R. Franson, MD, the company's vice president of global regulatory affairs.

Last but not least, if kidney damage has been formed by diabetes, the medical treatment should be applied as early as possible. In our Chronic Kidney Disease (CKD) Center, we do use Blood Pollution Therapy to deal with kidney damage. The treatment aims at treating the polluted blood not the kidneys. Under help of various techniques of cleaning blood, the wastes and toxins in blood can be discharged effectively and in the way, the internal environment of the body can be cleaned. Then, some effective reprative medicine and different elements can be supplied.

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Proteinuric Diabetic Kidney Disease More Likely in Minorities

Kidney damage from diabetes is called diabetic nephropathy. If the damage continues, your kidneys could fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease. In fact, diabetes is the most common cause of kidney failure in the United States. Other complications may be arteriosclerosis of the renal artery and protein in the urine.

Racial and ethnic minorities are more likely than non-Hispanic whites to have proteinuric diabetic kidney disease (DKD), according to new findings published online in Diabetes Care.

In a study of 15,683 individuals by Vivek Ghalla, MD, of Stanford University School of Medicine in Stanford, Calif., and colleagues, Hispanic men and women had a significant 34% and 46% increased odds of proteinuric DKD, respectively, compared with non-Hispanic whites, in adjusted analyses. Chinese men and women had a 56% and 39% increased odds of DKD, and Filipino men and women had an 85% and 57% increased odds. Non-Hispanic black women had a significant 50% increased odds. Our Email is kidneyhospitalabroad@hotmail.com.

Novel Racial/Ethnic Differences Found in Diabetic Kidney Disease

Diabetic kidney disease is a complication that occurs in some people with diabetes. Diabetic kidney disease takes many years to develop. In some people, the filtering function of the kidneys is actually higher than normal in the first few years of their diabetes. It can progress to kidney failure in some cases. Treatment aims to prevent or delay the progression of the disease. Most people with diabetes do not develop CKD that is severe enough to progress to kidney failure. Novel Racial/Ethnic Differences Found in Diabetic Kidney Disease

Rates of proteinuric and nonproteinuric diabetic kidney disease (DKD) vary significantly across racial/ethnic groups, according to a study published online in Diabetes Care.

To assess racial/ethnic differences in the prevalence of DKD, Vivek Bhalla, MD, of the Stanford University School of Medicine in California, and colleagues reviewed electronic health records (2008 to 2010) for 15,683 patients of non-Hispanic white (NHW), Asian (Asian Indian, Chinese, and Filipino), Hispanic, and non-Hispanic black (NHB) race/ethnicity with type 2 diabetes and without a previous history of kidney disease.

Compared with NHWs, racial/ethnic minorities had higher rates of proteinuric DKD (24.8% to 37.9% vs. 24.8%) and lower rates of nonproteinuric DKD (6.3% to 9.8% vs.11.7%). Compared with NHWs, Chinese women and men had a significant 39% and 56% increased odds of proteinuric DKD, respectively. Filipino women and men had a significant 57% and 85% increased odds, Hispanic women and men had a significant 46% and 34% increased odds, and NHB women had a 50% increased odds, after adjusting for confounding variables. In contrast, compared with NHWs, significantly lower odds of nonproteinuric DKD were observed among Chinese, Hispanic, and NHB women and Hispanic men.

"In summary, rates of proteinuric and nonproteinuric DKD vary significantly across racial/ethnic groups," the investigators wrote. "Additional prospective studies are needed to confirm these associations, as such studies could lead to improved public health surveillance of diabetes complications within diverse communities."

Novel Racial/Ethnic Differences Found in Diabetic Kidney Disease. If you want learn more informations, you can contact our online doctors, leave us messages or send email to kidneyhospitalabroad@hotmail.com, we will reply you within 24 hours.