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Diabetes mellitus (DM) is the second most common cause of chronic kidney disease in Brazil. This disease is associated with increased cardiovascular risk, the main cause of death in patients on hemodialysis (HD). Besides the increasing mortality, DM and its complications contribute to increased morbidity and decreased quality of life. Therefore, its appropriate management can contribute to reducing the prevalence of complications, morbidity, and mortality and increasing quality of life. Consequently, the present study aimed to characterize the management of DM and its chronic complications in HD patients.
This is a quantitative, descriptive, cross-sectional study, carried out through structured interviews, from September 2021 to September 2023, in three dialysis centers in the state of Paraíba, Brazil. The individuals included in the research were over 18 years old, diagnosed with chronic kidney disease, and had been on HD for more than three months.
Of the 176 patients interviewed, 61 (34.6%) were diagnosed with DM. The average age was 58.5 ±10.5 years, with an average time on dialysis of 26.5 ±26 months. 62.2% were male and 98.4% underwent HD through the public health system. 90.3% had a diagnosis of systemic arterial hypertension, 28.8% obesity, 44.2% had dyslipidemia, 15.3% had coronary artery disease, 9.6% had a previous stroke, and 5.7% had previous lower extremity amputation. 83.6% of patients claimed that the nephrologist is the coordinator of their health care. 39.3% have their DM medications prescribed by an endocrinologist and 36% by a nephrologist. 68.8% take insulin and 3.2% linagliptin. Despite the contraindication, 8% of patients used metformin. In 22.9% of cases, the nephrologist is the one who oversees checking glycemic control. 90% of patients do not have glycated hemoglobin recorded in their medical reports, and 54% of patients report having undergone the test more than a year ago. Regarding the disease screening for coronary artery with an electrocardiogram (ECG): 70.5% underwent it in less than one year. 41% of the ECG were requested by the cardiologist and 13% by the nephrologist. Diabetic retinopathy was screened in 78.7% of patients. 46% underwent screening in the last year. 15.7% were referred by the endocrinologist and 1.7% by the nephrologist. 31.5% mention that the frequency of the exam is variable, 21% annual and 10.5% quarterly. 52.6% had changes in the fundus of the eye and, of these, 50% were undergoing treatment. Regarding foot evaluation: 23% had their feet examined in the last year and 52.4% never had their feet evaluated. 32.1% of assessments were performed by endocrinologists and 21.4% by nephrologists. When evaluated, 64.2% only looked and touched their feet. Monofilament, in turn, was used in 35.8% of those examined. In 60.7%, the frequency of evaluations varied according to need. 32.1% had an ulcer on examination. 16.3% had symptoms of diabetic neuropathy. Of these, 30% were undergoing drug treatment.
The care of diabetic individuals on HD is below expectations. The nephrologist, despite being considered the coordinator of care for these patients, has not been a primary caregiver in tracking chronic complications of DM.