| [ Summary ] |
Diabetes mellitus (DM) is the foremost disease leading to introduction of dialysis. DM causes arteriosclerosis, retinopathy and peripheral neuropathy due to sustained hyperglycemia and metabolic abnormalities which lead to diabetic nephropathy (DMN). Vascular disorders, are often present before kidney function declines to the point where dialysis is deemed necessary. Cardiovascular complications are present in many cases. Because of this, overall evaluation of the patient's condition becomes even more important in deciding whether or not to begin dialysis. In cases where dialysis is chosen, there is no difference in survival rates for DMN patients whether HD or PD are chosen. However, the survival rate for DMN patients is clearly poor when compared to non-DMN patients. Because of the onset of visual disorders, orthostatic hypotension, dementia and difficulties with VA management, for DMN patients, assistance in transportation to the hospital, hospitalization, locating accepting facilities, painless methods for provideing hemodialysis and under certain circumstances, the discontinuation of dialysis must be taken into consideration. In these cases, carefully prepared palliative care must be implemented. |