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It is unanimously accepted that patients with diabetes have a higher likelihood for infections. The metabolic imbalance associated with diabetes suppresses the immunity system of the cutaneous organ. Hyperglycemia causes an increase of the activity of the sorbitol route with consumption of NADPH. Furthermore, the sorbitol from the cells leads to increase of osmolality in cells as well as reduction of intracellular myo-inositol. These strains on the cellular metabolism expose the cells to oxidative stress. An additional factor is the reduced chemotaxis and phagocytosis impact on the bacterial activity of leukocytes which leads to further predisposition of infection for diabetes patients. Hence the poor control of glycemic levels leads to immunity changes which affects the local immune response against the aggression of pathogenic agents.

Following the increase in incidence and prevalence of the risk factors responsible for the occurence of renal impairment is the increase of patients suffering from chronic kidney disease (CKD). As the renal function declines and the end stage of the chronic kidney disease is reached, it is necessary to start one of the following methods for substituting the renal function: renal transplantation, hemodialysis or peritoneal dialysis. The treatment of choice for most patients is hemodialysis, both in Romania and abroad in the international medical centers. According to official data, the number of patients undergoing hemodialysis is constantly growing. Hemodialysis adequacy evaluation instruments must be familiar among clinicians in order to provide a treatment that meets the quality standards.