[2] 24.5% % 53.0%[1] 3 ( ) [1] 75.2% 83% 29.2%

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1 [1] [2] % % % 53.0%[1] 3 ( ) 75.2% 83% 29.2% [2] %

2 [1] 8.4% [3] [4,5] [6,7] calcineurin inhibitors (tacrolimus) calcineurin inhibitor Mycophenolate mofetil and steroid tacrolimus cyclosporin Rapamycin Mycophenolate mofetil [8] (arteriovenous fistula) [9] icodextrin PH [10] ( ) % 75% 90% GFR 20 ml/min [11](American Diabetes Association) [12]30 ml/min (GFR)

3 ( )[13] [14] 5 8 mg/dl ( ) (steal syndrome) 1. (Ccr) 25 ml/min(cr) 4 mg/dl (AV graft) (Ccr) 20 ml/min (Cr) 5 mg/dl (Ccr) 15 ml/min (Cr) 6 mg/dl [15] PTFE [16] (Extended daily dialysis) (Nocturnal HD) [17] 2006 DOQI [18] Weber et al. polysulfone polyarylethersulfone [19] LAL assay ( EU/ml) 0.1 C.F.U./ml ( polysulfone) E [20] β 2 β 2 40% 70% β 2 80% β 2 [21] (Homocysteinemia)

4 ( ) (LVEF 40%) (baseline ECG) [22] ( ) 27% 50% [23] (Trendenlenburg s position) (saline bolus) nitroglycerin ( C)( ) (Isothermic dialysis) (3.0 meq/l) (α1 agonist) Midodrine (5 mg, 30 min before HD) L-carnitine (20 mg/kg, iv, post- HD) Sertraline ( mg/d) [24] (carbamoylation) HbA1C HbA1C 7%HbA1C 7% [25] 2006 (American Diabetes Association) mg/dl 180 mg/dl HbA1C 7% HbA1C 7.5% [26] 11mmol/liter [27] 1. US Renal Data System: 2002 Annual Data Report. Bethesda, MD, The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. 2. Ghavamian M, Gutch CF, Kopp KF, Kolff WH: The sad truth about hemodialysis in diabetic nephropathy. JAMA 1972; 222:

5 3. Conte F, Salone M: Italian Registry of Dialysis and Transplantation 2000 report. Available at org/sinridt.org.htm. 4. Becker BN, Brazy PC, Becker YT, et al: Simultaneous pancreas-kidney transplantation reduces excess mortality in type 1 diabetic patients with end-stage renal disease. Kidney Int. 2000; 57: Reddy KS, Stablein D, Taranto S, et al: Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis 2003; 41: Navarro X, Sutherland DER, Kennedy WR: Long-term effects of pancreatic transplantation on diabetic neuropathy. Ann Neurol 1997; 42: Matas AJ, McHugh L, Payne WD, et al: Long-term quality of life after kidney and simultaneous pancreas-kidney transplantation. Clin Transplant 1998; 12: Augustine JJ, Hricik DE: Steroid sparing in kidney transplantation: changing paradigms, improving outcomes, and remaining questions. Clin J Am Soc Nephrol 2006; 1(5): Serkes KD, Blagg CR, Nolph KD, Vonesh EF, Shapiro F: Comparison of patient and technique survival in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis: A multicenter study. Perit Dial Int 1990; 10: Chan TM, Yung S: studying the effects of new peritoneal dialysis solutions on the peritoneum. Perit Dial Int 2007; 27 (2): S Lhotta K, Zoebl M, Mayer G, Kronenberg F: Late referral defined by renal function: association with morbidity and mortality. J Nephrol 2003; 16(6): Summary of Revisions for the 2006 Clinical Practice Recommendations Diabetes Care 2006; 29: S Frimat L, Loos-Ayav C, Panescu V, Cordebar N, Briançon S, Kessler M: Early referral to a nephrologist is associated with better outcomes in type 2 diabetes patients with end-stage renal disease. Diabetes Metab 2004; 30(1): Wu MS, Lin CL, Chang CT, Wu CH, Huang JY, Yang CW: Improvement in clinical outcome by early nephrology referral in type II diabetics on maintenance peritoneal dialysis. Perit Dial Int 2003; 23(1): : K/DOQI Clinical Practice Guidelines for vascular access in Dialysis Patients. 17. NKF-DOQI.clinical practice guidelines for hemodialysis adequacy. National Kidney Foundation-Dialysis Outcomes Quality Initiative Cheung AK, Levin NW, Greene T, et al: Effects of high-flux hemodialysis on clinical outcomes: results of the HEMO study. J Am Soc Nephrol. 2003; 14(12): Weber V, Linsberger I, Rossmanith E, Weber C, Falkenhagen D: Pyrogen transfer across high- and low-flux hemodialysis membranes. Artif Organs 2004; 28(2): Satoh M, Yamasaki Y, Nagake Y, Kasahara J, Hashimoto M, Nakanishi N, Makino H:Oxidative stress is reduced by the long-term use of vitamin E-coated dialysis filters. Kidney Int 2001; 59(5): Lin CL, Huang CC, Yu CC, Yang HY, Chuang FR, Yang CW: Reduction of advanced glycation end product levels by online hemodiafiltration in long-term hemodialysis patients. Am J Kidney Dis 2003; 42(3): Ishio N, Kobayashi Y, Takebayashi H, et al: Impact of drugeluting stents on clinical and angiographic outcomes in dialysis patients. Circ J 2007; 71(10): Herzog CA, Ma JZ, Collins AJ: Comparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery and impact of diabetes. Circulation 2002; 106(17): Prakash S, Garg AX, Heidenheim AP, House AA: Midodrine appears to be safe and effective for dialysis-induced hypotension: a systematic review. Nephrol Dial Transplant 2004; 19(10): Oyibo SO, Pritchard GM, McLay L, James E, Laing I, Gokal R, Boulton AJ: Blood glucose overestimation in diabetic patients on continuous ambulatory peritoneal dialysis for end-stage renal disease. Diabet Med. 2002; 19(8): Kalantar-Zadeh K, Kopple JD, Regidor DL, et al: A1C and survival in maintenance hemodialysis patients. Diabetes Care 2007; 30(5): Simic-Ogrizovic S, Backus G, Mayer A, Vienken J, Djukanovic L, Kleophas W: The influence of different glucose concentrations in hemodialysis solutions on metabolism and blood pressure stability in diabetic patients. Int J Artif Organs 2001; 24: