[Recommendations for the management of diabetic patients with nephropathy]

In industrialized countries diabetic nephropathy is now the most common cause of end-stage renal disease and is associated not only with a high morbidity rate, but also a dramatic increase in mortality. The 5-year survival rate of diabetic patients on hemodialysis is 25-30% and is thus comparable with that of patients with colorectal cancer. The increasing numbers of diabetics on renal replacement therapy also put a great financial strain--on average 40,000-50,000 euros per patient and year--on our health care system. An increased rate of micro- and macrovascular complications is found already in early stages of diabetic nephropathy. Despite the existence of suitable screening methods and effective interventional strategies for these high-risk patients, their practical implementation leaves much to be desired. In particular there is much room for improvement in the cooperation between general practitioners, diabetologists and nephrologists.