An intraperitoneal insulin regimen for diabetics on continuous cyclic peritoneal dialysis.

Intraperitoneal insulin requirements were evaluated in six diabetic patients who were switched from continuous ambulatory peritoneal dialysis to continuous cyclic peritoneal dialysis. The mean total daily intraperitoneal insulin dose on continuous cyclic peritoneal dialysis was 85% of the mean dose on continuous ambulatory peritoneal dialysis (66 +/- 33 vs. 78 +/- 47 units/day, respectively, not significant), with comparable glycemic control. Twenty-five to 58% (mean value, 41%) of the total daily intraperitoneal insulin was administered in the diurnal exchange of the patients on continuous cyclic peritoneal dialysis. The ratio of the total intraperitoneal insulin dose on continuous cyclic peritoneal dialysis to the subcutaneous insulin dose predialysis was between 1.2 and 2.4 (mean value, 1.9). As guidelines for converting intraperitoneal insulin doses for patients switched from continuous ambulatory peritoneal dialysis to continuous cyclic peritoneal dialysis, we recommend starting continuous cyclic peritoneal dialysis with a total daily insulin dose 15% less than the continuous ambulatory peritoneal dialysis dose and giving approximately 40% of the total daily insulin dose in the diurnal exchange.

Atheroembolic involvement of renal allografts.

Renal atheroembolism is a well-recognized cause of renal insufficiency. Two renal allograft recipients with cholesterol atheroemboli in their allograft biopsies are described. In one patient, the origin of the atheroemboli was the recipient aorta while in the second patient the source was the donor. Renal allograft atheroembolism should be considered in elderly recipients or recipients of kidneys from older donors.