[Hemodialysis as renal replacement therapy of choice for diabetic patients]

Diabetes mellitus (DM) has become over the last decade the third cause of CKD-5 requiring launch of renal replacement therapy. Type 2 diabetes (DM2) representing 90% is a severe comorbid condition that is associated in almost 20% of dialysis patients in France. In spite major progresses in the management of diabetic dialysis patients, the cardiovascular morbidity and mortality is still very high. Recent reports indicate that mortality of DM2 patients in hemodialysis is close to 50% at two years. Hemodialysis or its alternatives (hemodiafiltration, hemofiltration) is still the most employed renal replacement modality in diabetic patients. Optimizing management of diabetic patients on hemodialysis relies on 6 major principles that are: early referral to nephrologist and start of RRT; early creation of native arteriovenous fistula; regular assessment of cardiovascular system; specific adaptation of the hemodialysis schedule (frequency, duration, type of membrane and dialysis fluid composition); fine tuning of medical treatment; specific and protocolized follow-up. Improving outcomes of diabetic patient with CKD-5 requires a multidisciplinary approach and a specific expertise of the nursing and medical team. Indeed, diabetic patient still pay a serious tribute to cardiovascular complications.