ABSTRACT
From August 1978 to December 1983, 51 insulin-dependent diabetic patients with end-stage renal disease were selected for treatment by continuous ambulatory peritoneal dialysis. There were 27 male and 24 female patients, with a mean age of 52.3 +/- 13.5 years. Forty-five patients dialyzed themselves by continuous ambulatory peritoneal dialysis and six were treated by continuous cyclic peritoneal dialysis. All patients were treated at home. The cumulative duration of treatment was 65.6 patient-years; 14 patients were dialyzed for at least 24 months. Extrarenal complications were frequent at start of continuous ambulatory peritoneal dialysis, including hypertension in 48 patients, proliferative retinopathy in 50, and cardiovascular complications in 30. Age appeared to be the major risk factor, with success rates at 2 years of 78% in patients under age 50 years and only 50% in patients over age 50. The main cause of death was vascular and the main cause of transfer to other therapeutic modalities was abdominal complications or malnutrition or both. Excellent control of blood pressure, uremia, and blood glucose levels was obtained on a daily program of four exchanges. Improvement in visual status was frequently observed, mainly in the young population. In patients with juvenile diabetes, continuous ambulatory peritoneal dialysis should be part of an integrated program with transplantation, while in the elderly, the method offers a unique opportunity for them to treat themselves at home.
Subject(s)
Diabetic Nephropathies/therapy , Kidney Failure, Chronic/therapy , Peritoneal Dialysis, Continuous Ambulatory , Adult , Aged , Cardiovascular Diseases/physiopathology , Diabetes Mellitus, Type 1/physiopathology , Diabetic Nephropathies/physiopathology , Diabetic Retinopathy/physiopathology , Evaluation Studies as Topic , Female , Humans , Hypertension/physiopathology , Male , Middle Aged , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Visual AcuityABSTRACT
Over the last five years, 46 insulin dependent diabetic patients (mean age 52 +/- 13 years) have been treated by continuous ambulatory peritoneal dialysis (CAPD). Fourteen patients have been on treatment for more than two years. Visual acuity assessed every six months showed that improvement has been observed in 14 eyes (19%), stabilisation in 36 eyes (46%), worsening in 17 eyes (21%), five eyes had a minimal function during the entire follow-up. Systolic blood pressure decreased from 173 +/- 42 mmHg at start of dialysis to 149 +/- 30 and 146 +/- 32 after one and two years. Mean fasting and post-prandial blood glucose assessed monthly in 36 patients treated with four daily intraperitoneal injections of insulin (660 determinations) were respectively 7.5 +/- 3.5 and 8.5 +/- 3.5mmol/L.
Subject(s)
Diabetic Nephropathies/therapy , Peritoneal Dialysis, Continuous Ambulatory , Peritoneal Dialysis , Adult , Aged , Blood Glucose/metabolism , Blood Pressure , Diabetic Nephropathies/physiopathology , Female , Humans , Male , Middle Aged , Visual AcuityABSTRACT
Evolution of visual function was assessed in 43 insulin-dependent diabetic (IDD) patients treated by maintenance haemodialysis (MH) for a cumulative duration of 1248 patient-months. At start of MH, 23 patients (46 eyes) still had good vision, 20 patients (40 eyes) were blind. All 40 blind eyes had severe proliferative retinopathy (PR) with additional irreversible complications in 32. Of the 46 eyes with preserved vision, PR was present in 24 (52.2%) with only 2 additional severe complications. Restoration of sight was obtained either spontaneously or after ophthalmic surgery in 6 eyes (7%). Stabilisation was achieved in 74% of eyes which retained vision at the start of MH. Two patients with eyesight at start of MH became blind (8.7%). Aggravation of visual function is mainly related to development of PR and not to haemodialysis per se. Careful ophthalmic follow-up, together with close control of diabetes, blood-pressure and uraemia can ensure preservation of vision in most IDD patients treated by MH.
