S 30 Plenary Session

Programme of the Session

Title: Diabetes and nephrology

GS: Josep Mª Gutierrez (Spain)
CKD diabetic patients-Same illness different care

O 79
Role of nursing in improving diabetic control and preserving renal function in diabetic patient
Nihal Khatib (Israel)

O 80
Quality of life of diabetic and non-diabetic haemodialysis patients in an urban area
Theodora Kafkia (Greece)

O 81
Follow-up of the fate of pre-dialysis diabetic patients between 2009 and 2015
Dalma Kulcsar (Hungary)

Abstracts

GUEST SPEAKER
CKD diabetic patients-Same illness different care
J. Mª Gutierrez

Abstract is not available 

 BIOGRAHPY OF THE GUEST SPEAKER

O 79
Role of nursing in improving diabetic control and preserving renal function in diabetic patient
N. Khatib¹, B. Ricon¹, K. Hasan¹, B. Layfer^1
1Preventive Nephrology, Clalit Health Services, Haifa and Westren Galil, Israel

Background
Diabetes is the leading cause of end stage renal disease and dialysis. The incidence of diabetes is rapidly increasing as are the number of patients with diabetic nephropathy that require dialysis. Supervision and care of diabetic patients is a challenge and require a multidisciplinary approach to decrease complications and to maintain proper control of diabetes.

Objectives
To improve diabetic control and to preserve renal function in patients with chronic kidney disease (CKD) due to diabetic nephropathy.

Methods
60 patients with CKD due to diabetic nephropathy and HbA1c>9% who inject insulin using an incorrect technique were enrolled in the study. All patients received frequent guidance from experienced dietetic and nursing staff including repeated technical guidance for proper injection techniques of insulin, treatment adherence and careful monitoring of blood glucose. Laboratory monitoring was performed at baseline and after 4 and 8 months.

Results
Mean age was 65.0 years, 56.4% were with morbid obesity (BMI>35kg/m2), 40.9% were smokers and only 8.2% engaged in physical activity. HbA1c decreased significantly at 4 and 8 months (p≤0.001). Diabetic control improved in 88.6% of participants at 8 months. No significant decrease in mean eGFR was observed during the study (p≥0.626). eGFR inversely correlated with HbA1c levels (p≤0.009). Levels of daily proteinuria were significantly decreased at 8 months.

Conclusion/Application to practice
Nursing staff play a central role in managing patients with diabetic nephropathy. This should include patient and family education and communication between the multidisciplinary team including primary health care clinics, diabetic clinics and dieticians.
BIOGRAPHY OF THE SPEAKER

O 80
Quality of life of diabetic and non-diabetic haemodialysis patients in an urban area
T. Falakidou¹, E. Minasidou^2, T. Kafkia², A. Dimitriadou², P. Tsaklis^3, I. Roudenko⁴, S. Spaia^1
1Dialysis Unit, "St. Paul" General Hospital, Thessaloniki, Greece; ²Department of Nursing, Alexander Technological Education Institute, Thessaloniki, Greece; ³Department of Physiotherapy, Alexander Technological Education Institute, Thessaloniki, Greece; ⁴Dialysis Unit, "Kyanous Stavros" General Clinic, Thessaloniki, Greece

Background
Chronic Kidney Disease (CKD) and Diabetes Mellitus (DM) have high prevalence and incidence, as well as great cost for patients, families and health services.   Within this context, the concept of Quality of Life (QoL) plays an important role, within the context of culture and values system and in relation to the individual's goals, expectations, standards and concerns.

Objectives
The aim of this study was to evaluate and compare QoL between two groups of haemodialysis patients, with and without Diabetes Mellitus. 

Methods
In order to evaluate QoL, the Kidney Disease Quality of Life questionnaire (short form) was used, along with epidemiological and demographic data. The study was conducted in a public hospital's Dialysis Unit in big city in Europe, during the second semester of 2014.

Results
Patients’ mean age was 71.5 (±11.03) years old and 62.5% (n=50) were males, 50% (n=40) diabetics.  Regarding vascular access, 57.5%(n=23) of the diabetics had an arteriovenous fistula, compared to 67.5%(n=27) of the non-diabetics.  The general and the mental health of non-diabetic dialysis patients was significantly better than diabetics.  Furthermore, cognitive and sexual function of non-diabetics dialysis patients were better than diabetics. Finally, men and younger patients had higher levels of physical and mental health.

Conclusion/Application to practice
Diabetic renal patients have to effectively manage two chronic diseases proven to negatively affect physical and mental health.  Assessement of their QoL helps healthcare professionals to measure acceptance and adaptation to the new health status. Maintaning or restoring quality of life is the main goal for any interventions practised by the multi-professional team.

BIOGRAPHY OF THE SPEAKER

O 81
Follow-up of the fate of pre-dialysis diabetic patients between 2009 and 2015
D. Kulcsar^{1, 2,} B. Udvardi-Bukits¹, I. Szakacs1, L. Kovacs^{1, 3}, I. Kulcsar^{1, 3
1}Dialysis Centre No. 6, B. Braun Avitum Hungary cPlc., Szombathely, Hungary; ²Klinik für Innere Medizin IV. Nephrologie und Hypertensiologie, Med. Univ., Innsbruck, Austria; ³Markusovszky Teaching Hospital, Szombathely, Hungary

Background
The number of patients with chronic kidney disease, including those suffering from diabetes mellitus (DM), increases from year to year.

Objectives
To compare the fate of those diabetic and non-diabetic patients in which the eGFR repeatedly reached or decreased below 20 ml/minute/1.73m2.

Methods
Out of the 759 patients included in the study, 391 (51.5%) were diabetic. The overwhelming majority (94%) of the patients are suffering from type 2 DM.

Results
At the start of care, the mean age of DM patients was 69.7±12.0 years and that of non-DM patients was 68.4±15.7 years. The mean follow-up time was 3.7±2.4 and 4.1±2.6 years in the DM and non-DM (nDM) group, respectively.
The proportion of patients still receiving care at present is 25% and 24%. The proportion of deceased patients was 17% and 16% in the DM and nDM group, respectively. Because of the improvement of renal function, 7% vs. 9% were returned to their family doctor’s care. The proportion of ‘vanished’ patients was 15% and 16%.
Thirty-five % of the patients was included in a dialysis program in both groups, the difference being that in the nDM group a higher proportion of dialysis patients (46.5% vs. 30.5%) opted for peritoneal dialysis (PD). Pre-emptive transplantation was performed on one DM patient and two nDM patients.

Conclusion/Application to practice
We did not find a notable difference in the fate of pre-dialysis DM and nDM patients, with the exception of the more expressed preference for PD observed in the nDM group.