Diabetes mellitus in dialysis: evolutionary aspects, 2003-2023

During the last 2 decades, the number of diabetics dialyzed annually in Moldova has increased 50 times simultaneously with a significant increase in morbidity with this pathology. We analyzed the evolution of the number and clinical features of chronically dialyzed diabetics in Moldova during the last 20 years. The processed data came from the annual reports of the Dialysis and Renal Transplantation Department of IMSP Republican Clinical Hospital ”Timofei Moșneaga”(2003-2015) and further from the ambulatory dialysis units „BB-Dialisă” S.R.L. (2016-2023). At the beginning of the new millennium diabetic patients consisted up to 2% of all chronically dialysis patients. With the increase of their number in Moldova, the number of diabetics, who received dialysis treatment, has been increasing steadily, reaching the ceiling of 10.9% of all dialysis patients at the end of 2015. Increased accessibility of dialysis services contributed to a rapid increase in the number of patients with this pathology in outpatient units during 2016-2019, up to 28.9%. At the same time, patients with diabetes suffered excess mortality following the COVID-19 pandemic, with their proportion falling to 14.9% in 2021. In the post-pandemic period again we see a continuous increase in the number of chronic DM patients dialysed, up to 22.3% in 2023. The main factors influencing the evolution of DM under dialysis in Moldova include: general increase in morbidity with DM, increased accessibility of dialysis service and awareness of the COVID-19 pandemic. Multidisciplinary collaboration is essential in improving the prognosis of diabetic patients on chronic dialysis.