Aspects of Insulin Treatment in Uremic Insulin-Dependent Diabetic Patients before and after Active Replacement Therapy

Since intensive metabolic control and vigorous antihypertensive therapy only postpone, but do not prevent, end-stage renal failure (ESRF) in diabetics and because diabetics in many parts of the world are no longer excluded from ESRF programs, it is not surprising that a great and still increasing number of candidates for dialysis therapy and kidney transplantation consist of diabetic patients. At the moment 10%–25% of the population admitted to ESRF programs in the United States and Western Europe suffer from diabetes mellitus. Consequently, profound insight into the pathophysiology of glucose homeostasis and insulin kinetics in this complicated clinical condition is necessary to assure optimal therapy in nondialyzed, dialyzed, and recently kidney-transplanted diabetic patients. A perfect glycemic and metabolic control is obviously still the goal of therapy in these diabetics in order to reduce further morbidity in a group of patients already heavily burdened by severe complications.