Kidney transplantation in diabetic patients with chronic kidney disease

Abstract

Diabetes mellitus is one of the major causes for chronic kidney disease in Brazil and worldwide. Chronic kidney disease stage V patients require renal replacement therapy: dialysis or kidney transplant. Although the majority of patients are on dialysis, this modality of treatment is associated to the lowest patient survival. Transplantation options for these patients include kidney transplantation with living donor, deceased donor or simultaneous kidney-pancreas transplantation. The aim of this study was to make a review on specific aspects of kidney transplantation in diabetic patients, to assess the impact of kidney transplantation on chronic complications of diabetes, and finally to show which would be the best transplantation modality for those patients. Concerning pre-transplant aspects, due to the high cardiovascular risk in those patients, the assessment of the coronary artery disease and peripheral arterial disease should be carried out in more details in the diabetic patient. Moreover, the study of miccional dysfunction is indicated due to the high prevalence of neurogenic bladder in those patients. As to chronic complications of diabetes, kidney transplantation can induce a stabilization of retinal lesions in most patients, improvement in the quality of life, improvement of the episodes of postural hypotension and gastrointestinal symptoms. With regard to transplant modalities available for diabetic patients, the best results for the patient and graft survival were attained by isolated kidney transplantation from living donor or simultaneous kidney-pancreas transplantation. The modality of kidney transplantation with deceased donor was associated to the worse survival rate both for patient and graft.