Stages 3 and 4 Chronic Kidney Disease with Diabetes in the older people

If one person suffering from Diabetes for a long time,therre will be damaged one's kidneys.If you don't adopt the right treatment.Diabetes may be lead to kidney Failure.

Dedicated European and US clinical guidelines for type 2 diabetes in the elderly have been released, but they do not specifically address the issue of advanced chronic kidney disease (CKD) in older patients with diabetes. General clinical guidelines have been published on the treatment of patients with diabetic nephropathy (DN), but these address the issue of how to prevent progression and treat advanced DN without distinguishing between different age groups. Elderly patients with diabetes and stages 3 to 4 CKD have particular needs that differ from those of younger patients with the same conditions. This is mainly due to their frailty and shorter life expectancy. Differently tailored therapeutic strategies are needed, which may have less stringent targets; and the use of common drugs should be critically evaluated. The management agenda (metabolic control, low-protein diet, controlling BP, preventing progression of advanced DN, preventing cardiovascular outcomes) for these patients is discussed in light of the limits and perspectives of current guidelines. Intensive, simultaneous management of all items on the agenda may not be feasible for a proportion of older patients, and clinicians may have to give priority to reducing some risk factors rather than others, choosing between different therapies.
In 2004, the European Diabetes Working Party for Older People launched its “Clinical Guidelines for Type 2 Diabetes Mellitus” specifically dedicated to the elderly (the European Diabetes & Aging Guidelines for short [EDAG]) (1). Guidelines for Improving the Care of the Older Persons with Diabetes Mellitus were also developed in the United States in 2003 (American Diabetes & Aging Guidelines for short [ADAG]) (2). There is a dual rationale behind guidelines specifically dedicated to the elderly. First, older people with diabetes have special needs. Second, with the demographic changes occurring in Western populations, the number of elderly individuals with diabetes is expanding dramatically. These people's life expectancy is considerably reduced: Whereas a 74-yr-old Western man without diabetes has an average life expectancy of approximately 10 yr and a woman of approximately 12 yr, when they have diabetes, their life expectancy is roughly 4 and 6 yr shorter for men and women, respectively (3).
Demographic changes in Western populations also have a significant impact on renal care. In many Western countries, the elderly now represent the most rapidly growing population initiating dialysis. In the United States, the median age of the incident population starting renal replacement therapy reached 64.6 yr in 2005, and the incidence of ESRD by age >75 yr was approximately 1500 pmp, 750 in Canada, and 500 in Italy (4). Because the prevalence of diabetes has been increasing among the elderly, it is hardly surprising that elderly individuals with diabetes contribute substantially to the overall burden of stage 5 chronic kidney disease (CKD) in Western countries. In 2005, in fact, one third of the incident cases of ESRD in the United States in people who were older than 75 yr had diabetic kidney disease (4).
Two very recently released publications are also of interest in the present contention, the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease (5) and the Quality Indicators for the Care of Vulnerable Elders (the Assessing Care of Vulnerable Elders 3 [ACOVE-3] initiative) (6). Only the former marginally addresses the issue that elderly people with diabetes and CKD warrant special treatment considerations, but neither of them nor the EDAG and ADAG specifically addresses the topic of advanced CKD in older patients with diabetes. This review aims to make up for this shortcoming relating to the treatment of elderly people with diabetes and advanced renal impairment (i.e., in stages 3 and 4 CKD). As the lower age limit, we consider patients between 70 and 80 yr because such long-lasting patients with diabetes are most likely to have a considerably reduced life expectancy and a number of diabetes-related comorbidities. The relevant clinical issue here, however, is the patients’ vulnerability, not their age, so our considerations could also be extended to younger, frail patients with diabetes and stages 3 to 4 CKD.

An attempt has been made to quote and grade the level of evidence. There is a sizable amount of good-quality research on the prevention and management of the complications of type 2 diabetes and related aspects, but most of it is not specific to elderly patients, and none of these studies concerned elderly people with advanced CKD. Most of the suggestions have consequently been classified simply as clinical practice recommendations (CPR), at the level of “opinion-based” advice, whereas a clinical practice guideline (CPG) has been proposed in just one case.

Treatments of CKD

In early stage of CKD you can use Chinese Medicine to control the development of kidney disease. If you has entered stage 3 or 4 stage of kidney disease.You can use some special treatment.Do you heard Micro-Chinese Medicine Osmotherapy.This therapy make the Traditional Chinese Medicine enter your kidneys through your skin directly.So the Chinese Medicine can quickly take affect.

If you also have other questions about your kidney Disease,or if you want to know therapy about CKD.Contact me through kidney-treatment@hotmail.com .