Chronic renal failure (CRF), which is the final stage of chronic kidney disease, is a condition when kidneys fail to perform their function and respond to the needs of a body (Nasri & Rafieian-Kopaei, 2015). CRF is a life-threatening disease because kidney functioning cannot be restored in its final stage. The most frequent causes of CRF are hypertension and diabetes. Thus, a study provides evidence that diabetes and hypertension are responsible for more than half of CRF cases in the United States (Nasri & Rafieian-Kopaei, 2015). This literature review uses a descriptive analysis approach and aims to investigate the peculiarities of CRF in diabetic patients, opportunities for its prevention, and treatment strategies that consider conditions of patients with diabetes.
Chronic Renal Failure in Diabetic Patients
Diabetes mellitus and renal failure are closely interrelated. Thus, diabetes mellitus as a metabolic disease can lead to renal failure, which, in turn, results in an increased need for insulin among diabetic patients (Nasri & Rafieian-Kopaei, 2015). At the same time, non-diabetic patients with CRF do not observe hyperglycemia unless they do not have a genetic predisposition. The study by Nasri and Rafieian-Kopaei (2015) proves that oxidative stress, which develops as a result of an imbalance between “free radical formation and antioxidant defense capacity,” catalyzes some chronic diseases that are hard to cure, such as diabetes (p. 1114). Moreover, oxidative stress leads to the development of diabetic kidney disease, which also causes renal failure. A study by Bailey, Wang, Zhu, and Rupnow (2014) reveals that type 2 diabetes is a primary cause of chronic kidney disease in the United States. Thus, about 40% of patients with diabetes have symptoms of chronic kidney disease. Moreover, diabetes is considered a reason for CFR in 44.2% of dialysis patients.
Chronic Renal Failure Prevention
One of the major opportunities to prevent CRF is the early detection of risk factors that cause it. Thus, it is important to control patients with diabetes and hypertension who are at a higher risk of CRF development. To identify CRF in diabetic patients, it is necessary to screen these individuals for proteinuria and assess their renal function (McFarlane, Gilbert, MacCallum, & Senior, 2013). Moreover, renal damage in patients with diabetes can be monitored through intensive glycemic control. Also, McFarlane et al. (2013) suggest that CRF can be prevented in case of slowing down the progression of diabetic nephropathy. It can be fulfilled due to the use of medications that disrupt the renin-angiotensin-aldosterone system.
According to Nasri and Rafieian-Kopaei (2015), the development of CRF can be prevented due to amelioration of diabetes and renal damage that can be achieved due to buffering the production of reactive oxygen species (ROS). One of the possible ways to reduce ROS generation is antioxidant therapy. While the role of antioxidants in the prevention and treatment of diabetes and renal failure is not properly investigated, some preclinical reports provide evidence of their positive impact on both conditions (Nasri & Rafieian, 2015). Also, Nasri and Rafieian-Kopaei (2015) suggest that renal failure development can be controlled due to the early treatment for its risk factors such as hypertension.
Chronic Renal Failure Treatment Strategies
The selection of CRF treatment strategies should consider other patient’s conditions including diabetes. Thus, it needs a complex approach involving such aspects as lifestyle measures, glycemic control, and cardiovascular outcomes (Perkovic et al., 2016). Thus, diet and exercise have the potential to improve a patient’s condition because excessive salt intake, sedentary lifestyle, as well as obesity, are related to an increased risk of mortality among CRF patients (Perkovic et al., 2016). Glycemic control as a part of treatment is essential because diabetes is one of the proven risks for CRF. Thus, therapy can include glucose-lowering agents. However, hypoglycemia should be avoided. According to Perkovic et al. (2016), cardiovascular outcomes can be controlled through lipid-lowering and antiplatelet and antithrombotic therapy. Still, additional studies are necessary to investigate their effect on CRF in diabetic patients. On the whole, treatment of CRF consists of two major aspects such as managing the cause of the disease and its complications. Still, when the final stage of kidney disease is diagnosed and kidneys fail to perform their functions, there are only two options to consider, dialysis and kidney transplant.
On the whole, chronic renal failure is a condition caused by many factors. One of the significant agents leading to CRF is diabetes mellitus. Their interdependence should be considered during treatment as well as the selection of preventive strategies for CRF. Thus, chronic kidney disease is a frequent consequence of diabetes and in case of diabetes is not managed properly, it can develop into renal failure. In its acute stage, renal failure cannot be treated and patient condition can be improved through the procedure of dialysis. Finally, a kidney transplant can be necessary to restore kidney function. Therefore, chronic renal failure is a condition that should be prevented at earlier stages of chronic kidney disease. Moreover, attention should be paid to risk factors mitigation. Measures should be taken to manage such conditions as diabetes and hypertension since they increase the risk of CRF development.
Bailey, R., Wang, Y., Zhu, V., & Rupnow, M. (2014). Chronic kidney disease in US adults with type 2 diabetes: an updated national estimate of prevalence based on Kidney Disease: Improving Global Outcomes (KDIGO) staging. BMC Research Notes, 7(1), 415. Web.
McFarlane, P., Gilbert, R., MacCallum, L., & Senior, P. (2013). Chronic kidney disease in diabetes. Canadian Journal of Diabetes, 37, S129-S136. Web.
Nasri, H., & Rafieian-Kopaei, M. (2015). Diabetes mellitus and renal failure: Prevention and management. Journal of Research in Medical Sciences, 20(11), 1112-1120. Web.
Perkovic, V., Agarwal, R., Fioretto, P., Hemmelgarn, B., Levin, A., Thomas, M., … Groop, P.-H. (2016). Management of patients with diabetes and CKD: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference. Kidney International, 90(6), 1175-1183. Web.