Dialysis Initiation

Ideally, all diabetic patients approaching ESRF should be involved in the development of their own personalised care plan. This will enable a negotiation of the necessary dietary changes leading up to and extending to the initiation of elective dialysis (3).

Dialysis guidelines from the National Kidney Foundation promote the early initiation of RRT for diabetic patients, due to an increased susceptibility to uraemic symptoms at lower serum creatinine levels than non-diabetic subjects (4). Early RRT for diabetic renal failure not only relieves the symptoms of nausea, anorexia and vomiting but also helps reduce overall mortality. However, despite these recommendations, dialysis is frequently delayed due to either personal resistance or inadequate dialysis resources.

Some diabetic patients with already compromised renal function, will require the emergency initiation of dialysis during an intercurrent illness. However, this does not mean that all will require long-term RRT.

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