The developing role of the renal diabetes nurse

Diabetes as a chronic disease is often complicated in its management, particularly when combined with chronic and end-stage renal failure. Patients, carers and health care professionals are unfortunately often confused by either too little or conflicting advice provided by the two specialist teams. Within this context, the Renal Diabetes Nurse (RDN) role serves to bridge the gap by ensuring effective links and communication. Currently, renal referrals are made from surrounding secondary care settings and primary care GP practices. The expansion of renal outreach clinics, the appointment of new consultant nephrologists and the emergence of nurse-led clinics, reflects our continuous growth to meet the demand for renal services. The number of patients with renal failure and diabetes is set to increase as the acceptance criteria are clarified and referral routes made explicit. An ageing population with 21-62% of the renal population over the age of 65 (depending on the location of the renal unit), coupled with an increase in the Asian and African-Caribbean population all contribute to increased patient numbers. It is now well recognised that these patients often experience associated generalised atheroma and vascular calcification from inadequately managed hypertension and diabetes over a number of years. Consequently, this group of patients are often "high maintenance" requiring input from the multidisciplinary team on a continuing basis.