Analysis of Factors in the Prognosis of Diabetics on Continuous Ambulatory Peritoneal Dialysis (CAPO): Long Term Experience

Abstract

After five years of treating diabetics by continuous ambulatory peritoneal dialysis (CAPD), we analyzed the factors involved in prognosis. Forty-one patients were included in the study, with a cumulative experience of 784 months. Good control of blood glucose was obtained with intraperitoneal (i.p.) insulin and the blood pressure was controlled in 87% of patients without medication, which probably favored the stabilization of visual acuity in 60% of 15 patients evaluated after two years. The follow-up of patients was longer in those who began CAPD with a higher residual creatinine clearance. In spite of the large number of patients who were blind or had very poor vision, 83% of all patients were self-sufficient and well-trained for CAPD, and 39% were able to work full time. The incidence of peritonitis declined to 1 episode per 17.5 patient months associated with the introduction of new preventive measures. Patients over 50 years old had the highest mortality rate and myocardial infarction was the main cause of death. Patient survival at 6, 12, 24, 36, and 42 months was 100, 90, 80, 62, and 62%, respectively. Age and cardiac problems are important factors in survival. Self-sufficiency, rehabilitation, and low incidence of peritonitis are also important factors in the life quality of diabetic patients on CAPD.

Diabetic Patients on Peritoneal Dialysis

“…Advanced age represents an important predictor of survival in diabetic CAPD patients, and diabetic patients 55 years or older on CAPD had a significantly decreased survival compared with nondiabetics, although there was no significant difference in survival between diabetic and nondiabetic patients under age of 55 years (21). Early studies that analyzed prognostic factors in diabetic patients on CAPD (22) found that patients over 50 years old had the highest mortality rate and that myocardial infarction was the main cause of death. They concluded that age and cardiac disease are important predictors of survival, and they identified that age above 45 years, a previous or present cardiac disease and a systolic BP of above 160 mmHg were the most important predictors of survival in CAPD patients with diabetic nephropathy (23).…”

“…The presence of a variety of comorbid conditions such as peripheral vascular disease, cerebrovascular disease, cardiovascular disease, hypoalbuminemia, and hyperparathyroidism, at the initiation of PD, may increase the mortality of diabetic patients on PD. Atherosclerotic vascular disease is common in diabetics of all ages and cardiac disease is the most frequent cause of death among diabetics, when compared with nondiabetics (1,22). Furthermore, during PD, diabetic patients often develop protein–energy malnutrition (PEM) more rapidly than do nondiabetics, and this a common cause of PD technique failure in diabetics on long‐term dialysis that contributes to their increased mortality (20,25).…”