pattern of diabetic nephropathy among Saudi patients with non insulin-dependent diabetes mellitus

There were no studies on the different stages of diabetic nephropathy in Saudi Arabia, particularly the earliest stages. We have therefore investigated the frequency of occurrence of varying degrees of proteinuria including microalbuminuria in noninsulin-dependent diabetes mellitus [NIDDM] Saudi patients as well as the correlation of varying degrees of proteinuria with other diabetic complications and risk factors. One hundred and twenty-five NIDDM patients were studied. Fifty-seven were males and 68 were females. Their mean age was 49.8 +/- 10 years with a mean duration of diabetes of 9.48 +/- 6 years. The mean of HbAlc was 10.3 +/- 2.6%, serum creatinine was 76.7 +/- 23 mmol/L, creatinine clearance 94.3 mL/min, glomerular filtration rate 129.7 +/- 44 and effective renal plasma flow was 496.5 +/- 153. The pattern of proteinuria group was as follows: nephrotic range proteinuria 5.6%, clinical proteinuria 30.4%, microalbuminuria 16.8%. Hypertension and retinopathy were present in 36.8% and 37% of the patients respectively. A significant correlation was found between the presence of hypertension, duration of diabetes and development of diabetic nephropathy. Similarly, a significant correlation was found between retinopathy and the degree of proteinuria. In conclusion, the pattern of diabetic nephropathy in the Saudi NIDDM patients is similar to that in the Western world. Hypertension and duration of diabetes mellitus are important risk factors in the development of diabetic nephropathy. There is a good correlation between retinopathy and the degree of proteinuria

Non-peritonitis complications of continuous ambulatory peritoneal dialysis in Saudi Arabia

Although peritonitis is the major complication and leading cause of morbidity in patients undergoing continuous ambulatory peritoneal dialysis [CAPD], there are other complications of this long-term renal replacement therapy [RRT] modality. In order to evaluate the non-peritonitis complications, we retrospectively studied 60 new patients who were accepted in our CAPD program over a period of eight years from 1984 to 1993. Out of the 60 patients, 31 were females and 29 were males, with a mean age of 37.0 +/- 18 years. Tenckhoff's catheter was implanted by surgeons under direct vision in the operating theater through a midline incision. Nine of our patients had previous abdominal surgery and 11 females had pregnancies before CAPD, ranging from one to 10 with a mean of four. A total of 49 episodes of complications were observed, 32 early and 17 late. Early complications were defined if they occurred within three months from starting the procedure and late complications were defined as occurring after this period. There were 15 catheter blocks [25%], nine dialysate leaks [15%] and five hemoperitoneums [8.3%]. Two serious and unusual complications were observed. In one of our patients, a mesenteric blood vessel injury occurred during catheter insertion, which necessitated massive blood transfusions and laparotomy. The other patient developed intestinal obstruction due to obstruction of intestinal loops around the catheter; this was corrected by removal of the catheter without the need for laparotomy. The late complications included six hernias, three hydroceles, three exit site infections, three tunnel infections and one case of loss of ultrafiltration

Comparison between continuous ambulatory peritoneal dialysis and in center hemodialysis

The data on 39 patients on hemodialysis and 19 on continuous ambulatory peritoneal dialysis [CAPD] were compared in term of correction of metabolic abnormalities, types of complications necessitating admission, and total cost of each modality of torment. The mean age of patients on hemodialysis was 42 years and that of those on CAPD was 39 years. Mean duration of follow-up was 21 months for hemodilalysis patients and 14 months for CAPD patients. There were on significant differences in the biochemical profiles between the two groups apart from the total CO2 which was significantly higher in CAPD patients than hemodialysis patients. There was no statistical difference in the mean hemoglobin values, the transfusion requirements were markedly different. On the whole CAPD patients needed more days in hospital for initial work-up and for treatment of complications than did HD patients. The cost of CAPD was significantly less than hemodialysis [3714 SR per patient per monthversus 6108 ER per patients per months] but this difference become less once hospitalization costs are considered as part of the cost for-care for CAPD patients [8364 SR per patients per month for hemodialysis versus 6534 SR per patients per months for CAPD]