When to start dialysis in diabetic patients?

Diabetic nephropathy and diabetes related nephropathies represents one of the most common causes of end-stage renal disease (ESRD), and diabetic patients with chronic renal failure represent the most important high risk cohort of uraemic patients requiring renal replacement therapy. Interventions to slow progression of kidney disease and measures to reduce the risk of cardiovascular disease are highly effective in early renal damage and should be the main task of nephrologists, but diabetic patients are more frequently referred late to the nephrologist. Factors involved in the rate of mortality of diabetic patients with ESRD are multiple, including nutritional status, co-morbidity, age, etc, but the duration and quality of pre-dialysis nephrological care constitute a key for improving outcomes of diabetic patients with ESRD.