Nephrologist’s Note features timely information provided by physicians in the greater tri-state area.
Diabetes is fast becoming the epidemic of the 21st Century. According to the
American Diabetes Association, some 1.3 million new cases are diagnosed each
year. Diabetes can cause a variety of serious complications including kidney
failure. With the attentive care of a primary care physician and a nephrologist,
proactive patients with good control of their diabetes may be able to delay
the onset of end stage renal disease. For many with diabetes, the organ transplant
options available today can both prolong and improve the quality of life.
Diabetes is a chronic illness that often causes a steady decline in renal function once the kidney is affected. There are two paths of treatment for end stage renal disease associated with diabetes — organ transplantation and dialysis. I recommend that patients explore both options early in the course of their disease, usually when the kidney function gets below 25 percent, so they are prepared to make educated choices as the effects of diabetes advance.
People with diabetes have several transplant options. They may receive
a kidney transplant or they may be eligible to
receive both a kidney and pancreas transplant.
A pancreas transplant is perhaps the best thing
that can happen for a person with Type I diabetes. A successful pancreas
transplant essentially cures the recipient of his or her diabetes.
Patients no longer need to check blood sugar levels or inject insulin.
A pancreas transplant prevents any further complications of diabetes
and in some cases can even reverse mild symptoms. Because the human
body has only one pancreas, the transplanted organ must be provided
by a deceased donor.
If a patient’s kidney function falls below 10 - 15 percent, he or she should begin dialysis treatments to remove toxins from the blood stream or receive a kidney transplant to replace the failing organ. Unfortunately, the high risk complications of diabetes can advance more quickly once the patient begins dialysis. If a patient is fortunate enough to receive a kidney transplant before dialysis is necessary or shortly after dialysis begins, they can avoid high rates of infection at the catheter, graft or fistula site and heart disease that often results from prolonged dialysis. A kidney transplant can come from a living donor or a deceased donor.
Another transplant option offers a solution to both diabetes and
any resulting kidney disease. Patients can receive
a kidney and a pancreas transplant during the same surgery, or they
can receive a pancreas transplant after their successful kidney transplant.
Regardless of the treatment option patients choose, it should be
part of an aggressive health plan that includes
close monitoring of all the body systems. It is vital that people
with diabetes and their nephrologists work together to control blood
pressure and cholesterol levels. Daily exercise should be a part
of every patient’s
health care plan. Smoking should be avoided.
To learn more about the treatment for kidney disease, visit the
National Kidney Foundation web site at www.kidney.org.
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By Chandra B. Chandran, M.D., Nephrologist, Fair Lawn, NJ
