Chronic Peritoneal Dialysis in the Management of Diabetics with Terminal Renal Failure

Abstract

Twelve diabetics with terminal renal failure were maintained on chronic peritoneal dialysis (PD) for 2–28 months (average 10 months). 7/12 survived more than 1 year. Blood glucose levels were well controlled by the use of supplemental, intradialysis, intraperitoneal insulin. The incidence of dialysis-related complications, including peritonitis was not significantly higher than in controls. Neurophysiological studies revealed a high incidence of neuropathy initially with progression in most patients. Radiological studies revealed initial vascular calcifications in 7 out of 12 patients with progression in 4. Retinopathy did not progress significantly. PD is a suitable alternative to hemodialysis in the management of end-stage diabetic nephropathy.

Absorption and Action of Insulin Added to Peritoneal Dialysate in Dogs

“…With interest in the use of long term. maintenance peritoneal dialysis [18][19][20] and the application of this method of treatment to patients with end-stage diabetic nephropathy [1][2][3][4][5][6], a method for preven tion and management of hyperglycemia during dialysis is desirable. Supplemental doses of subcutaneous insulin can be given, but this procedure has several disadvantages: first, wide variations in plasma glucose may occur.…”

“…The use of long-term maintenance peri toneal dialysis in uremic patients with diabetes mellitus [1][2][3][4][5][6] and the occasional occurrence of severe hyperglyce mia and even hyperosmolar coma during peritoneal dia lysis [7,8] indicate the need for an effective and convenient method for the control of blood glucose levels. Supple mental injections of insulin are sometimes employed, but blood glucose control may be erratic and hypoglycemia can occur in the immediate postdialysis period [1].…”

“…There fore. the addition of insulin to peritoneal dialysate has been suggested as a method for controlling hyperglycemia during peritoneal dialysis [6,[9][10][11]. Little is known about the transperitoneal movement of insulin and its consequent biologic action.…”

Diabetic Nephropathy: Natural Course, Survivorship and Therapy

“…Nevertheless, the course of a total of 94 diabetics treated with chronic peritoneal dialysis has been reviewed from 6 centers including our own (table VII) [29,55,[63][64][65]. 1 year survival is 60.5% (table V, A).…”

“…Thus, neuropathy has variously been reported to progress slowly [64] or to sta bilize [29,55,65], Visual acuity remains unchanged in most patients [29,50,[63][64][65], but does deteriorate in approximately one third of patients [55]. However, it is generally accepted that cardiac and peripheral vascular disease progress [29,63], In the single reported study which addresses this question, 40% of the patients devel oped myocardial infarction and/or congestive heart fail ure [63].…”