Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo

Abstract Number : 70
MANAGEMENT OF DIABETIC PATIENT
WITH END STAGE RENAL DISEASE (ESRD)

Prof.Mohamed Hany Hafez, Cairo University,
 Egypt

Diabetic nephropathy became the leading cause of ESRD (25% to 42%) in Europe, Japan and the United States. This percentage is less in Egypt, but increased prevalence of type 2 diabetes in all age groups and improved survival of population including proteinuric patients permits a greater proportion to progress to ESRD. Because only 30-40% of diabetic patients will develop nephropathy, genetic factors are important in progression despite the same risk 
factors e.g. ACE DD genotype patients have more albuminuria, severe diabetic
glomerulopathy lesions, worse progression and higher mortality once dialysis is 
Initiated. Tertiary prevention of overt diabetic nephropathy aiming at preventing or delaying ESRD depends on control of hypertension, albuminuria,
and blood glucose. Limiting dietary protein and avoiding smoking could be renoprotective. Remission of albuminuria to less than 600 mg/day and regression defined as rate of decline of GFR of 1ml/min/year was reported. Even immunosuppression by mycophenolate mofetil was reported to prevent glomerular injury in diabetic rats. ACE inhibitors, AIIR antagonists, Advanced glycosylation end product inhibition and glycosaminoglycan therapy have been evaluated in clinical trials. There are several reasons for early dialysis of diabetic patients including rapid deterioration of renal functions with uremic symptoms and difficulty in hypertension control. There is continuing debate over whether peritoneal dialysis (PD) or hemodialysis is the optimal initial dialysis therapy. A recent report shows that PD was associated with 24% higher mortality during first year of treatment. From the Canadian renal failure registry, diabetics under the age of 45 years have a marked increase in incidence of ischemic heart disease, Cerebrovascular accidents and peripheral vascular disease. Because of the improved quality of life and long-term survival,renal transplantation remains the treatment of choice for most patients.Close monitoring for infections including TB ,viral and fungal infections is important . Control of Blood Sugar 
could be more difficult with the diabetogenic effect of immunosuppressive.
Pancreatic and Islet cell transplantation together with the renal graft remain the 
best goal, although still away from wide clinical application.

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