Haemodialysis for renal failure in diabetes mellitus - abstract

The prognosis for diabetic patients with end-stage renal disease (ERSD) treated by all modalities of renal replacement therapy is not as good as for non-diabetics. The literature, prior to 1976, reported a very poor prognosis for diabetic patients treated by haemodialysis. With the widespread introduction of continous ambulatory peritoneal dialysis (CAPD) in the 1970s, this was advocated as the dialysis treatment of choice for diabetic patients with ERSD. Several large studies reported after the mid-1980s do not confirm any significant advantage of CAPD over haemodialysis for diabetic patients. The results for long-term haemodialysis in patients with diabetes mellitus have improved tremendously over the last two decades. In most renal failure programmes in the world (England, New Zealand and Southern Europe excepted), diabetes mellitus is the leading cause of ERSD, and over 80 per cent of these patients are treated by haemodialysis. Although transplantation continues to show superior results to dialysis, the fact remains that older and sicker patients are treated by haemodialysis while the younger patients with less co-morbid conditions are accepted for transplantation. Also, haemodialysis for ERSD has results approaching those for cadaveric renal transplantation when adjustments for age and co-morbid conditions are made (AU)

Successful treatment of renal allograft rejection in the presence of cytomegalovirus disease. A report of two cases.

We report 2 patients who developed cytomegalovirus (CMV) infection following renal transplantation. Both patients were treated with 9-(1,3-dihydroxy-2-propoxymethyl) guanine (ganciclovir). In the presence of CMV disease, both patients also had progressive elevations of the serum creatinine, which were attributed to graft rejection. Antirejection therapy was administered, with OKT3 in one case and pulse methylprednisolone in the other. Renal function improved in both patients, and CMV disease abated. These cases unique because antirejection therapy was instituted in the presence of documented CMV disease, without adverse sequelae. We believe that the administration of ganciclovir lessened the severity of CMV infection, while allowing the rejection episodes to be aggressively treated.