ABSTRACT
Ideally, diabetics should be referred to a nephrologist at an early stage, and there is much to be said for joint diabetologist/nephrologist outpatient clinics to assess diabetic patients with renal disease. Referral should be carried out in any event if serum creatinine concentration reaches or exceeds 250 m mol/l. Plans for renal replacement therapy need to be made early in diabetic patients owing to their tendency to develop pulmonary oedema due to poor cardiac performance in the face of salt and water overload, and plans for vascular or peritoneal access (see Chapter 11) should be put in train at an earlier stage than in non-diabetics.
