Management of adults with diabetes on the haemodialysis unit: summary of new guidance from the Joint British Diabetes Societies (JBDS) and the Renal Association

Authors

  • Andrew Frankel Imperial College Healthcare NHS Trust, London, UK
  • Sara Kazempour-Ardebili Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Iran
  • Rachna Bedi Imperial College Healthcare NHS Trust, London, UK
  • Tahseen A Chowdhury The Royal London Hospital, Whitechapel, London, UK
  • Parijat De Birmingham City Hospital (Sandwell and West Birmingham Hospitals NHS Trust), Birmingham, UK
  • Nevine El-Sherbini Imperial College Healthcare NHS Trust, London, UK
  • Fran Game Derby Teaching Hospitals NHS Foundation Trust and University of Nottingham, UK
  • Sara Gray East & North Herts NHS Trust, UK
  • Dawn Hardy East & North Herts NHS Trust, UK
  • June James University Hospitals of Leicester NHS Trust, UK
  • Marie-France Kong University Hospitals of Leicester NHS Trust, UK
  • Gabby Ramlan North Middlesex University Hospital NHS Trust, UK
  • Elizabeth Southcott St James University Hospital, Leeds, UK
  • Peter Winocour Queen Elizabeth II Hospital, Welwyn Garden City, UK

DOI:

https://doi.org/10.15277/bjd.2016.073

Keywords:

diabetes, end-stage renal failure, chronic kidney disease, haemodialysis, guideline

Abstract

Diabetic nephropathy remains the principal cause of end-stage renal failure (ESRF) in the UK, as elsewhere in the developed world, and its prevalence is set to increase. People with diabetes and ESRF on maintenance haemodialysis are a highly vulnerable group, often with complex comorbidities, who are at high risk of adverse cardiovascular outcomes, which is the leading cause of mortality in this population. The management of people with diabetes receiving maintenance haemodialysis is shared between diabetes and renal specialist teams and the primary care team, with input from additional healthcare professionals providing foot care, dietary support and other aspects of multidisciplinary care. In this setting, one specialty may assume that key aspects of care are being provided elsewhere, which can lead to important components of care being overlooked. People with diabetes and ESRF require improved delivery of care to overcome organisational difficulties and barriers to communication between healthcare teams. No comprehensive guidance on the management of this population has previously been produced. These national guidelines, the first in this area, bring together in one document the disparate needs of the diabetes patient on maintenance haemodialysis. The guideline is based on the best available evidence, or on expert opinion where there is no clear evidence to inform practice. We aim to provide clear advice to clinicians caring for this vulnerable population and to encourage and improve education for clinicians and patients to promote patient empowerment and self-management.

References

UK Renal Registry. 2014 – The Seventeenth Annual Report. Available at https://www.renalreg.org/reports/2014-seventeenth-annual-report/(accessed Feb 2016).

United States Renal Data System. 2012 Atlas of CKD & ESRD. Available at http://www.usrds.org/atlas12.aspx (accessed Feb 2016).

Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA 2007;298:2038-47. http://dx.doi.org/10.1001/jama.298.17.2038

Joint British Diabetes Societies and Renal Association. Management of adults with diabetes on the haemodialysis unit. http://www.diabetologists-abcd.org.uk/jbds/jbds.htm

Atherton G. Renal replacement and diabetes care: the role of a specialist nurse. J Diabetes Nursing 2004;8:70-2.

National Kidney Foundation. KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update. Am J Kidney Dis 2012;60:850-86. http://dx.doi.org/10.1053/j.ajkd.2012.07.005

Shima K, Chujo K, Yamada M, et al. Lower value of glycated haemoglobin relative to glycaemic control in diabetic patients with end-stage renal disease not on haemodialysis. Ann Clin Biochem 2012;49:68-74. http://dx.doi.org/10.1258/acb.2011.011161

Ansari A, Goldsmith D, Krimholtz M, et al. Measuring glycaemic control in renal failure. Diabet Med 2001;18:70A (abstract).

Gunton JE, McElduff A. Hemoglobinopathies and HbA(1c) measurement. Diabetes Care 2000;23:1197-8. http://dx.doi.org/10.2337/diacare.23.8.1197

Herman WH, Cohen RM. Racial and ethnic differences in the relationship between HbA1c and blood glucose: implications for the diagnosis of diabetes. J Clin Endocrinol Metab 2012;97:1067-72. http://dx.doi.org/10.1210/jc.2011-1894

Uzu T, Hatta T, Deji N, et al. Target for glycemic control in type 2 diabetic patients on hemodialysis: effects of anemia and erythropoietin injection on hemoglobin A(1c). Ther Apher Dial 2009;13:89-94. http://dx.doi.org/10.1111/j.1744-9987.2009.00661.x

Diabetes UK. ISO Standards for Blood Glucose Meters. Available at http://www.diabetes.co.uk/blood-glucose-meters/iso-accuracy-standards.html (accessed February 2016).

Riveline JP, Teynie J, Belmouaz S, et al. Glycaemic control in type 2 diabetic patients on chronic haemodialysis: use of a continuous glucose monitoring system. Nephrol Dial Transplant 2009;24:2866-71. http://dx.doi.org/10.1093/ndt/gfp181

Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577-89. http://dx.doi.org/10.1056/NEJMoa0806470

Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005;353:2643-53. http://dx.doi.org/10.1056/NEJMoa052187

Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358:2545-59. http://dx.doi.org/10.1056/NEJMoa0802743

VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009;360:129-39. http://dx.doi.org/10.1056/NEJMoa0808431

ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-72. http://dx.doi.org/10.1056/NEJMoa0802987

ACCORD Study Group. Chronic kidney disease and intensive glycemic control increase cardiovascular risk in patients with type 2 diabetes. Kidney Int 2015;87:649-59. http://dx.doi.org/10.1038/ki.2014.296

Park J, Lertdumrongluk P, Molnar MZ, et al. Glycemic control in diabetic dialysis patients and the burnt-out diabetes phenomenon. Curr Diab Rep 2012;12:432-9. http://dx.doi.org/10.1007/s11892-012-0286-3

Fonseca VA, Alvarado-Ruiz R, Raccah D, et al. Efficacy and safety of the once-daily GLP-1 receptor agonist lixisenatide in monotherapy: a randomized, double-blind, placebo-controlled trial in patients with type 2 diabetes (GetGoal-Mono). Diabetes Care 2012;35:1225-31. http://dx.doi.org/10.2337/dc11-1935

Bouchi R, Babazono T, Onuki T, et al. Administration of insulin glargine thrice weekly by medical staff at a dialysis unit: a new insulin regimen for diabetic management in physically impaired patients undergoing hemodialysis. Diabetology Int 2011;2:197-201. http://dx.doi.org/10.1007/s13340-011-0044-9

Shoji T, Emoto M, Mori K, et al. Thrice-weekly insulin injection with nurse's support for diabetic hemodialysis patients having difficulty with self injection. Osaka City Med J 2012;58:35-8.

Willingham F. The dietary management of patients with diabetes and renal disease: challenges and practicalities. J Renal Care 2012;38(Suppl 1):40-51. http://dx.doi.org/10.1111/j.1755-6686.2012.00283.x

Fissell RB, Bragg-Gresham JL, Gillespie BW, et al. International variations in vitamin prescription and association with mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2004;44:293-9. http://dx.doi.org/10.1053/j.ajkd.2004.04.047

Fouque D, Vennegoor M, ter Wee P, et al. European best practice guideline on nutrition. Nephrol Dial Transplant 2007;22(Suppl 2):ii45-ii87. http://dx.doi.org/10.1093/ndt/gfm020

Joint British Diabetes Societies, Diabetes UK. The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus. March 2010. Available at http://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_ Hypo_Adults.pdf (accessed Feb 2016).

Rider JA, Foresti-Lorente RF, Garrido J, et al. Gastric bezoars: treatment and prevention. Am J Gastroenterol 1984;79:357-9.

Stolic R. Obesity in renal failure – health or disease? Med Hypotheses 2010;75:497-500. http://dx.doi.org/10.1016/j.mehy.2010.07.004

Chazot C, Gassia JP, Di Benedetto A, et al. Is there any survival advantage of obesity in southern European haemodialysis patients? Nephrol Dial Transplant 2009;24:2871-6. http://dx.doi.org/10.1093/ndt/gfp168

National Institute for Health and Care Excellence (NICE). Public Health Draft Guidance. Managing overweight and obesity in adults – lifestyle weight management services. Available at https://www.nice.org.uk/guidance/ph53/documents/overweight-and-obese-adults-lifestyle-weight-management-draft-guidance2 (accessed Feb 2016).

Moen MF, Zhan M, Hsu VD, LD et al. Frequency of hypoglycaemia and its significance in chronic kidney disease. Clin J Am Soc Nephrol 2009;4:1121-7. http://dx.doi.org/10.2215/CJN.00800209

Kazempour-Ardebili S, Lecamwasam VL, Dassanyake T, et al. Assessing glycemic control in maintenance hemodialysis patients with type 2 diabetes. Diabetes Care 2009;32:1137-42. http://dx.doi.org/10.2337/dc08-1688

Su G, Mi S, Tao H, et al. Association of glycemic variability and the presence and severity of coronary artery disease in patients with type 2 diabetes. Cardiovasc Diabetol 2011;10:19. http://dx.doi.org/10.1186/1475-2840-10-19

Esposito K, Ciotola M, Carleo D, et al. Post meal glucose peaks at home associate with carotid intima media thickness in type 2 diabetes. J Clin Endocrinol Metab 2008;93:1345-50. http://dx.doi.org/10.1210/jc.2007-2000

Cavalot F, Petrelli A, Traversa M. Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J Clin Endocrinol Metab 2006;91:813-19. http://dx.doi.org/10.1210/jc.2005-1005

Muggeo M, Verlato G, Bonora E, et al. Long term instability of fasting plasma glucose, a novel predictor of cardiovascular mortality in elderly patients with non-insulin dependent diabetes mellitus: the Verona Diabetes Study. Circulation 1997;96:1750-4. http://dx.doi.org/10.1161/01.CIR.96.6.1750

Hanefeld M, Cagatay M, Petrowitsch T, et al. Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long term studies. Eur Heart J 2004;25:10-16. http://dx.doi.org/10.1016/S0195-668X(03)00468-8

Margolis DJ, Hofstad O, Feldman HI. Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes. Diabetes Care 2008;31:1331-6. http://dx.doi.org/10.2337/dc07-2244

Ndip A, Rutter MK, Vileikyte L, et al. Dialysis treatment is an independent risk factor for foot ulceration in patients with diabetes and stage 4 or 5 chronic kidney disease. Diabetes Care 2010;33:1811-16. http://dx.doi.org/10.2337/dc10-0255

Game F. Preventing amputations in patients with diabetes and renal disease. Practical Diabetes 2012;29:324-8.

Game FL, Chipchase SY, Hubbard R, et al. Temporal association between the incidence of foot ulceration and the start of dialysis in diabetes mellitus. Nephrol Dial Transplant 2006;21:3207-10. http://dx.doi.org/10.1093/ndt/gfl427

Ndip A, Lavery LA, Lafontaine J, et al. High levels of foot ulceration and amputation risk in a multiracial cohort of diabetic patients on dialysis therapy. Diabetes Care 2010;33:878-80. http://dx.doi.org/10.2337/dc09-2007

Diabetes UK. End of Life Care (October 2013). Available at https://www.diabetes.org.uk/end-of-life-care (accessed Feb 2016).

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2016-05-18

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