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


  • 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



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


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.


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