[Nutrition of patients with diabetes and chronic kidney disease]

One third of the patients with Diabetes present a Chronic Kidney Disease. Despite cardiovascular events and increased mortality, Diabetes is the first cause of End Stage Renal Disease. The nutritional status of theses patients widely varies, from obesity to malnutrition, according to their type of diabetes, the severity of the renal disease, and the frequent concurrent diseases: it conditions their dietary counselling. The patients with type 2 diabetes and obesity have to moderate and well choose their alimentary lipids, for body weight control and to reduce their cardiovascular risk; this works in the context of a multifactorial approach as demonstrated by the Steno 2 trial. The use of insulin or conventional insulin-secretagogues (sulfonylureas, glinids) needs patients to be educated about their carbohydrate intake, especially when the good glucose control exposes to hypoglycaemia. Moderation of protein intake reduces proteinuria, an improved outcome has been demonstrated for patients with type 1 diabetes and nephropathy on a Low Protein Diet. The patients who require dialysis often deteriorate their nutritional status, the protein intake must be increased at this stage.