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Managing Diabetic Patients on Dialysis: The Nurse and Practitioners’ Role in Multidisciplinary Team Essentials. 

By:  Dr. Gary D. Goldberg, PhD
Clinical Professor of Medical Education, and Consultant
Angeles College of Nursing,
Los Angeles, California

ABSTRACT  

BACKROUND FINDINGS:    

Diabetic patients on dialysis -  

     The chronic state of diabetes mellitus (DM) mainly type II, is an increasingly common cause of end stage renal disease (ESRD) in all countries, accounting for 51% of dialysis patients in the U.S. and 39% in Europe. [1]  Patient survival is much worse than for non-diabetic patients, with a large proportion of patients dying within the first 3 months of dialysis (excluded from USRDS data).   See:  Hypertension, dialysis and clinical nephrology at http://www.hdcn.com//. [2]   In North America, chronic diabetes (e.g., poorly controlled), has shown as a major cause of death associated with cardiovascular diseases. [3]  Usually the outcome is better for transplanted patients. 

      Many of the non-renal complications of diabetes will continue to progress after initiation of dialysis, including: 

F     coronary artery disease

F     Retinopathy

F     Cataracts

F     Cerebrovascular disease

F     Peripheral vascular disease

F     Neuropathy

F     Autonomic dysfunction

F     Moreover, notable depression. 

     Many times discussion is made on an individual basis, but continuous ambulatory peritoneal dialysis (CAPD) is frequently the preferred option.  There are advantages and disadvantages similar to other dialysis patients.  As a nurse or practitioner, you will learn the disadvantages of haemodialysis (HD) also; vascular instability and increased cardiac risk, difficulty creating vascular access, increased hypotension on dialysis, and an increased hypoglycaemia may accrue.  

In addition, CAPD offers no cardiac instability or need for access, but increased glucose loads, weight gain and sometimes difficulties with diabetic control will accrue.  In some patients, visual disturbances may impair the ability to perform CAPD exchanges, but can usually be overcome.    In the outpatient clinic setting, the nurse can teach the patient proper techniques and waste handling.      

      Approaching patients on haemodialysis -      

     Chronic renal failure affects every aspect of a person’s life.  Patients will experience complex physical, psychological, and social problems.  It can be very difficult to come to terms with receiving haemodialysis (HD) treatment three or four times each week.  Nurses and practitioners should be sensitive to the needs of patients and stresses caused by end stage renal disease (ESRD). 

     The relationship between the nurse and patient will take on a unique role and will continue through several different treatments modalities.  The most important aspect in maintaining the trust between the nurse and the patient is developing a partnership in care.  It is essential that the nurse explains and discusses all aspects of HD treatment with the patient.  Without this involvement, patients can experience loss of control and increased dependence on the nursing staff. 

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