Abstract
The attending physician treating a patient with diabetes is frequently confronted with the simultaneous presence of both diseases: diabetes and reduced kidney function. Patients with diabetes are at high risk of developing kidney disease in comparison with general population, and timely evaluation for the decline of renal function in these patients is very important.
Many metabolic changes namely the enhanced catabolism at progressive loss of renal function, diminished gluconeogenesis and glycogenolysis, pharmacokinetic changes of medicaments including antidiabetics should be taken into account at the decrease of glomerular filtration rate below 60 ml/min (1 ml/sec). Comprehensive knowledge of the antidiabetic drugs mechanism of action and their metabolisms seems to be absolutely necessary to prevent side effects of such therapy and patient damage, specifically hypoglycaemia and drug interactions.
Management and treatment of diabetes becomes a multidisciplinary task with a participation of a nephrologist. The wide role of nephrologist in the care of diabetic patient is not only limited to the management of diabetic complications and choice of appropriate antidiabetic drug therapy adjusted to renal function, but also includes verification of kidney diagnosis and exclusion of other or coincidence nephropathy.