Rychlík I, Sulková S
Diabetologické centrum 3. lékarské fakulty UK a FN Královské Vinohrady, Praha.
Vnitr Lek. 2003 May;49(5):395-402.
In the nineties of the 20th century diabetic nephropathy has become the leading cause of regular dialysis treatment (RDT) in developed countries. In particular type 2 diabetics are involved. A similar trend can be observed also in the Czech Republic which holds in this respect the first place among countries of the former eastern block (33% patients with RDT) suffer from diabetes. The cause of the increase of patients with diabetic nephropathy and renal failure caused by diabetes is not only the rising prevalence and incidence of type 2 diabetes in the population but in particular the better care provided to patients with type 2 diabetes which enables them to survive macro- and microvascular complications incl. diabetic nephropathy. It is estimated that diabetic nephropathy affects 4-8% patients attending diabetic clinics. With regard to the increasing number of diabetics in RDT, moreover associated with their high polymorbidity, this is a serious medical and economic problem. The main factors which influence in the diabetic patients the risk of development of diabetic nephropathy are long-term control of glycaemia, genetic (ethnic) factors, age and sex. The decisive factor influencing in patients with diabetic nephropathy the progression of chronic renal insufficiency is control of the blood pressure. Including diabetics in RDT is not associated only with medical problems but also with socio-economic issues. The quality of life of diabetics is much lower and the survival of diabetics treated within the framework of RDT is still almost half as compared with the survival of non-diabetic patients. Decision on the selection of the dialysis method is not easy. Medical differences are well defined but should not be considered absolute. It is important to consider also which method is preferred by the patient. Optimally the decision is taken during the period of dispensarization. Both dialyzation methods have comparable results and survival although for diabetics under 50 years of age a more favourable prognosis of peritoneal dialysis is reported. However, the risk of "failure of the method" is in general higher in peritoneal dialysis.
在20世纪90年代，糖尿病肾病已成为发达国家定期透析治疗（RDT）的主要原因。尤其涉及2型糖尿病患者。在捷克共和国也可观察到类似趋势，在这方面，捷克在前东欧国家中位居首位（33%的RDT患者）患有糖尿病。糖尿病肾病患者和糖尿病所致肾衰竭患者增加的原因，不仅是人群中2型糖尿病患病率和发病率的上升，特别是对2型糖尿病患者提供了更好的护理，使他们能够在包括糖尿病肾病在内的大血管和微血管并发症中存活下来。据估计，糖尿病肾病影响4% - 8%就诊于糖尿病诊所的患者。鉴于RDT中糖尿病患者数量的增加，而且他们还伴有高共病率，这是一个严重的医学和经济问题。影响糖尿病患者发生糖尿病肾病风险的主要因素是血糖的长期控制、遗传（种族）因素、年龄和性别。影响糖尿病肾病患者慢性肾功能不全进展的决定性因素是血压控制。将糖尿病患者纳入RDT不仅涉及医学问题，还涉及社会经济问题。糖尿病患者的生活质量要低得多，在RDT框架内接受治疗的糖尿病患者的生存率仍几乎是非糖尿病患者的一半。选择透析方法的决定并不容易。医学差异已明确界定，但不应视为绝对。考虑患者更喜欢哪种方法也很重要。最佳情况是在非卧床医疗期做出决定。两种透析方法的结果和生存率相当，尽管据报道，50岁以下的糖尿病患者腹膜透析的预后更有利。然而，一般来说，腹膜透析的“方法失败”风险更高。
