ABSTRACT
Epidemiological investigations have shown that approximately 2-3% of all Austrians have diabetes mellitus with renal involvement, leaving 250,000 people in Austria affected. The risk of occurrence and progression of this disease can be attenuated by lifestyle interventions as well as optimization of blood pressure, blood glucose control and special drug classes. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society of Nephrology for the diagnostic and treatment strategies of diabetic kidney disease.
Subject(s)
Diabetes Mellitus , Diabetic Nephropathies , Nephrology , Humans , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/therapy , Austria , Blood Pressure , Life Style , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapyABSTRACT
Recent epidemiological investigations have shown that approximately 2-3% of all Austrians suffer from diabetes with renal involvement, i.â¯e. 250,000 people in Austria are affected. The risk of occurrence and progression of this disease can be ameliorated by life style interventions as well as optimization of blood pressure, blood glucose levels and special drug classes. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society for Nephrology for the diagnostics and treatment strategies of diabetic kidney disease.
Subject(s)
Diabetic Nephropathies , Diet Therapy/standards , Exercise Therapy/standards , Practice Guidelines as Topic , Austria , Blood Pressure , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/therapy , Humans , Life Style , Risk Reduction Behavior , Treatment OutcomeABSTRACT
Recent epidemiological evaluations have shown that approximately 5% of all Austrians suffer from diabetes including renal involvement, i. e. 400.000 people in Austria are affected. The risk of start and progression of this disease can be ameliorated by lifestyle interventions as well as optimization of blood pressure and glucose levels. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society for Nephrology for the prevention and treatment of diabetic kidney disease.
Subject(s)
Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/therapy , Diet Therapy/standards , Exercise Therapy/standards , Practice Guidelines as Topic , Risk Reduction Behavior , Austria , Evidence-Based Medicine , Humans , Treatment OutcomeABSTRACT
Diabetes mellitus is the leading single cause for renal replacement therapy. Its development and progression, however, can be ameliorated by adequate therapy. The present article represents the recommendations of the Austrian Diabetes Association and the Austrian Society for Nephrology for the prevention and treatment of diabetic nephropathy.
Subject(s)
Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/therapy , Practice Guidelines as Topic , Renal Replacement Therapy/methods , Renal Replacement Therapy/standards , Austria , Humans , Renal Replacement Therapy/trendsABSTRACT
Increasing life expectancy results in an increased number of elderly cancer patients. Comorbidities and functional impairment influence the patient's course of disease and the choice of antineoplastic treatment. The Comprehensive Geriatric Assessment (CGA) supports the appraisal of the patient's individual health characteristics, especially due to the fact that chronologic age does not always correlate with the patient's health. Next to the appraisal of comorbidities and functional impairment, nutritional state, cognitive impairment, psychological state, social support, quality of life and the patient's medication are recorded. The Society of Geriatric Oncology (SIOG) recommends the CGA in cancer patients older than seventy years. While planning a systemic antineoplastic therapy, renal, hepatic, cardiac and bone marrow insufficiencies have to be considered. Renal and hepatic impairment often cause in dose reduced antineoplastic treatment, whereas in patients with cardiac insufficiency liposomale substances and in patients with decreased bone marrow function growth factors are available. Additionally to the oncological treatment, an early involvement of palliative care specialists should be considered.
Subject(s)
Geriatric Assessment , Neoplasms/epidemiology , Age Factors , Aged , Antineoplastic Agents/therapeutic use , Antineoplastic Agents/toxicity , Comorbidity , Cooperative Behavior , Health Status Indicators , Humans , Interdisciplinary Communication , Neoplasms/diagnosis , Neoplasms/drug therapy , PrognosisABSTRACT
Since the introduction of peritoneal dialysis (PD) into clinical nephrology at the end of the 1970s, many improvements have led to acceptance of this method as renal replacement therapy equivalent to hemodialysis. It is unclear whether the diabetic patient is the ideal candidate for PD and if this procedure should be the preferred method of treatment of renal failure in these patients, especially when kidney transplantation cannot be performed. PD may provide several advantages for diabetic patients with end-stage renal failure; for example, better hemodynamic stability is achieved during peritoneal ultrafiltration and vascular access surgery becomes unnecessary. On the other hand, the continuous glucose absorption may lead to increased insulin requirements, obesity and hyperlipidemia. Furthermore, peritoneal protein loss may aggravate malnutrition, which is frequently present in these patients. However, for a differentiated assessment of outcome in PD, the individual history (diabetes type 1 or type 2) and accompanying comorbidity of diabetic patients have to be considered. Nowadays nephrologists have to be aware of the concept of individualized therapy, which is integrated into an overall plan and takes into account the different conditions of diabetic patients and their treatment options. By improving removal of sodium and water, as well as improving quality of metabolic control, new dialysis solutions (icodextrin, neutral-pH solutions) and automated PD could have a positive impact on outcome in diabetic patients. In contrast, from retrospective studies on PD there is evidence of higher long-term mortality rates in elderly women with diabetes and in patients with cardiac insufficiency than in those on hemodialysis. Further research is necessary in order to optimize individualized therapy for diabetic patients with end-stage renal disease in the future.
Subject(s)
Diabetic Nephropathies/therapy , Kidney Failure, Chronic/therapy , Peritoneal Dialysis/mortality , Peritoneal Dialysis/methods , Austria/epidemiology , Diabetic Nephropathies/complications , Humans , Kidney Failure, Chronic/complications , Patient Selection , Peritoneal Dialysis/adverse effects , Practice Guidelines as Topic , Practice Patterns, Physicians' , Prognosis , Survival Rate , Treatment Outcome , United States/epidemiologyABSTRACT
Diabetes mellitus is the leading single cause for renal replacement therapy. Its development and progression, however, can be ameliorated by adequate therapy. The present article represents the recommendations of the Austrian Diabetes Association for the prevention and treatment of diabetic nephropathy.
