Comparative Results Between Dialysis and Transplantation in Diabetic Patients

Rao, Kamakshi V.; Sutherland, D; Kjellstrand, C.M.; Najarian, J S; Shapiro, F.L.

doi:10.1097/00002480-197700230-00112

Cited by 25 publications

(12 citation statements)

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“…The Mayo Clinic [53] and the University of Minnesota [51] report that 67 and 82%, respectively, of their transplanted diabetic patients achieve an acceptable level of rehabilitation, defined as a return to an active life-style. These figures are substan tially better than those which have been reported for hemodialyzed diabetics, which range from 23 to 66% [8, 25,27,49,54,89] and those for peritoneally dialyzed patients, of 30-50% [29,63].…”

Section: Rehabilitationmentioning

confidence: 70%

“…Cardiovascu lar disease and cerebrovascular accidents account for the largest proportion of deaths in most series but infection remains an important factor in fatal outcome (table VI). In addition, as many as 15-30% of patients may volun tarily withdraw from hemodialysis because of dissatisfac tion with the quality of their lives [52][53][54]57],…”

Section: Survival Datamentioning

confidence: 99%

“…Most older series report a deterioration in vision [8,24,25,27,29,49,54,58,59], with as many as 14-41 % of patients developing blindness while on hemodialysis [24, 60,61]. Factors such as heparinization, rapid fluid shifts, hyperglycemia alternating with hypoglycemic episodes, and continued hypertension (as well as hypotension) have been cited as possible contributing factors [24, 25,61,62].…”

Section: Morbidity Factorsmentioning

confidence: 99%

“…There have been several reports of a beneficial effect of transplantation on neuropathy with greater improvement in motor than in sensory function [61,72,80,82,83], Autonomic neuropathy, however, may continue to be troublesome. Furthermore, the pro gression of visual abnormalities may be arrested [1,3,54,71,73,74,77,78,80,83,84], Indeed, in one report from the University of Minnesota, 9 patients (15%) regained functional vision having previously been considered blind [54]. When vision does deteriorate following trans plantation, it is often related to the development of cata racts [75,81], As in those diabetics treated with dialysis, cardiovas cular disease does progress in the posttransplant period [1,2,74], Peripheral vascular disease appears likewise to be unremitting, as evidenced by the fact that between 13 and 50% of these patients have been reported to require amputation of some portion of the extremities [1, 63, 72, 74.…”

Section: Morbidity Factorsmentioning

confidence: 99%

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Diabetic Nephropathy: Natural Course, Survivorship and Therapy

1981

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Diabetes mellitus is a disease with major social and economic consequences. End-stage renal disease (ESRD) due to diabetes occurs in as many as 30% of patients with juvenile diabetes, providing a large percentage (up to 33%) of all patients in need of therapy for ESRD. We have reviewed the natural course of the nephropathy in type I diabetes mellitus and the results of dialysis and transplantation therapy with particular regard to survival and morbidity. Comparisons of the survival of diabetic patients among peritoneal dialysis, hemodialysis, and transplantation are complicated by the lack of sufficient data for peritoneal dialysis and by the bias introduced by patient/treatment selection methods. Presently, it appears that transplantation with a living related donor graft offers the best survival for both graft and patient, with a definite reduction of morbidity associated with the complications of diabetes. Cadaveric transplantation is approximately the equivalent of hemodialysis in patient survival at 1 year and also appears to offer a somewhat diminished morbidity. Peritoneal dialysis data are sparse and skewed by patient selection. However, there is some emerging evidence that therapy with this modality may be associated with a delay in progression of retinopathy, when compared with hemodialysis.

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Section: Rehabilitationmentioning

confidence: 70%

Section: Survival Datamentioning

confidence: 99%

Section: Morbidity Factorsmentioning

confidence: 99%

Section: Morbidity Factorsmentioning

confidence: 99%

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Diabetic Nephropathy: Natural Course, Survivorship and Therapy

1981

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“…In contrast to the 1970s when chronic diabetics Nampoory/Johny/Costandi/Gupta/Nair/ Samhan/Al-Muzairai/Al-Mousawi were rarely accepted for any form of renal replacement therapy, they are now regularly accepted for all types of renal replacement therapy. The survival rate of uremic diabetic patients treated with chronic hemodialysis was extremely poor compared to those who had kidney transplantation and nondiabetic dialysis patients [2][3][4][5]. However, with improvements in hemodialysis, transplantation and advent of chronic ambulatory peritoneal dialysis, 1-year survival of uremic diabetics has increased to 70% [6].…”

Section: Introductionmentioning

confidence: 99%

Inferior Long-Term Outcome of Renal Transplantation in Patients with Diabetes mellitus

et al. 2002

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Objective: To retrospectively review the long-term outcome of renal transplant in diabetics at Mubarak Al-Kabeer Hospital and Hamad Al-Essa Organ Transplant Center, Kuwait from 1983 to 1998. Methods: There were 631 renal transplant patients, comprising 79 (12.5%) patients with pretransplant diabetes mellitus (pre-TDM), 117 (18.5%) patients with post-transplant diabetes mellitus and 435 (69%) nondiabetics (ND). Subjects with post-transplant diabetes mellitus were excluded from the comparative analysis. Distribution of sex, source of donors and mode of immunosuppression were similar in pre-TDM and ND groups. Results: Fifty-three (67%) recipients in pre-TDM and 90 (20.5%) in the ND group (p < 0.01) were above 45 years of age. However, 26 (33.3%) pre-TDM and 345 (79.5%) ND were below age 45. Among those who died, coronary artery disease led to death in 36% of pre-TDM and 27% in ND. Hyperlipidemia requiring drug therapy was observed in 37% pre-TDM and 6% ND. The incidence of severe infections was nearly twice in pre-TDM over ND recipients (1.9 vs. 1.0 per patient, p < 0.001). Acute rejection episodes were more frequently seen in pre-TDM (43%) than ND (33%), however the difference was not statistically significant. The patient survivals at 1, 5, 10, 14 years were significantly lower in pre-TDM (84, 65, 58 and 58%, respectively) than in ND (97, 93, 86 and 82%, respectively). The major contributory factors were severe infections and coronary artery disease. The cumulative graft survival showed a similar pattern (52% in pre-TDM, 73% in ND at 10 years). However, when death is excluded, the 10-year pure graft survival probability was similar for the pre-TDM and ND groups (76% vs. 80%). Conclusion: Our study indicates poor patient survival in pre-TDM due to coronary artery disease and infections, whereas the pure long-term graft survival was equally good in pre-TDM and ND transplant recipients.

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Idiopathic Membranous Glomerulonephritis in Diabetic Patients

Rao¹

1980

Arch Intern Med

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Comparative Results Between Dialysis and Transplantation in Diabetic Patients

Cited by 25 publications

References 0 publications

Diabetic Nephropathy: Natural Course, Survivorship and Therapy

Diabetic Nephropathy: Natural Course, Survivorship and Therapy

Inferior Long-Term Outcome of Renal Transplantation in Patients with Diabetes mellitus

Idiopathic Membranous Glomerulonephritis in Diabetic Patients

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