Referral of type 1 diabetic patients to a nephrology unit: will pre-emptive transplantation change our life?
BACKGROUND
Type 1 diabetic patients are a small but challenging subset of chronic kidney disease. The new frontiers of pancreas-kidney transplantation may enhance the need for early referral.


OBJECTIVE
To analyze the referral pattern of type 1 diabetics to a specialized Nephrology Unit, and to quantify the indications for pancreas or pre-emptive pancreas-kidney transplantation at referral in this population.


METHODS
Setting of study was a Nephrology Outpatient Unit, dedicated to diabetics, active since 1986; period of study 1991--2002. The main biochemical and clinical parameters were analyzed at referral. Indications for transplantation were put at: serum creatinine (sCr)> or =2 mg/dL or > or =3 mg/dL and/or nephrotic syndrome. Pancreas: lesser degrees of functional impairment without worsening after FK-506 challenge.


RESULTS
90 type 1 diabetics were referred: 48 males, 42 females; median age: 38 (18-65) years; median diabetological follow-up 20 (3-37) years; sCr 1.2 (0.6-7) mg/dL, proteinuria 0.9 (0-12.3) g/day; creatinine clearance: 58 (6-234) ml/min; Hbalc: 8.8% (5.9-14), diastolic blood pressure: 80 (55-100) mmHg, systolic blood pressure: 137.5 (70-180) mmHg. 85.6% had signs of end-organ damage due to diabetes. 67% of the patients had diabetic nephropathy, 20.7% hypertensive with or without diabetic nephropathy. According to the chosen criteria, 30.6% had indications for pancreas-kidney graft (sCr > or = 2 mg/dL), 25.9% considering sCr > or = 3 mg/dL; 28.2% further patients could be considered for isolated pancreas graft.


CONCLUSIONS
At referral to the nephrologist, over 50% of type 1 diabetics may have indications for pancreas-kidney or pancreas graft; an earlier multidisciplinary work-up is needed to optimize an early pre-emptive transplant approach.
Chair of Nephrology, Department of Internal Medicine, University of Turin, Turin, Italy. gbpiccoli@yahoo.it
Giorgina B
GB
Piccoli
Elisabetta
E
Mezza
Miriam
M
Gino
Giorgio
G
Grassi
Giorgio
G
Soragna
Fabrizio
F
Fop
Manuel
M
Burdese
Massimo
M
Gai
Daria
D
Motta
Bernardino
B
Malfi
Maura
M
Rossetti
Franco
F
Dani
Alberto
A
Jeantet
Giuseppe P
GP
Segoloni
D000293:Adolescent; D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003928:Diabetic Nephropathies / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D012017:Referral and Consultation