Dialysis in Diabetics

Chazan, Bernard I.

doi:10.1001/jama.1969.03160260030007

Cited by 29 publications

(7 citation statements)

References 13 publications

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“…It may be increased [47][48][49], de creased [13] or remain about the same [50]. We have found that insulin requirements showed no significant change.…”

Section: Discussionmentioning

confidence: 95%

Diabetic Nephropathy

Sg²

1978

Nephron

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The clinical course of diabetic nephropathy was evaluated in 150 patients and the effect of hemodialysis in 68 of them. Proteinuria was the first sign of renal disease. Once renal dysfunction becomes evident, there is a rapid deterioration leading to dialysis within 3.0 ± 0.2 years. Hypertension and circulatory congestion are common complications. The hypertension is probably volume dependent. Retinopathy was not invariably present at the onset of renal insufficiency but appeared with progression of renal failure. The course during hemodialysis was complicated by continued progression of diabetic vascular disease manifested by vascular access difficulties, worsening of retinopathy and blindness, and cardio- and cerebrovascular deaths. Mortality was higher than in nondiabetic dialysis patients.

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“…It may be increased [47][48][49], de creased [13] or remain about the same [50]. We have found that insulin requirements showed no significant change.…”

Section: Discussionmentioning

confidence: 95%

Diabetic Nephropathy

Sg²

1978

Nephron

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“…An increase in brain parenchy mal fluid has been demonstrated both by com puterized tomographic (CT) [1] and nuclear magnetic resonance [2] scanning techniques and this is supported by post mortem studies of patients who died during haemodialysis treatment showing cerebral oedema and even tentorial herniation in some cases [3], In patients undergoing regular haemodi alysis, symptoms may be minimal consisting of restlessness and headache but occasion ally nausea, vomiting, blurring of vision and even fitting may occur [4], The majority of patients recover with appropriate medical treatment. However, a significant morbidity and mortality occurs in those patients who become comatose after fitting [5].…”

Section: Introductionmentioning

confidence: 83%

Management of Patients with Renal Failure Complicated by Cerebral Oedema

Davenport

Finn²,

Goldsmith³

1989

Blood Purif

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Dialysis disequilibrium due to cerebral oedema still causes a significant degree of both morbidity and mortality. We discuss the management of 5 such cases and demonstrate the improved stability during treatment with continuous veno-venous haemofiltration. This may be due to the improved osmotic stability during haemofiltration with a resultant decrease in the osmotic gradient across the blood-brain barrier.

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“…The goal of future treatment must therefore be kidney transplantation, as it makes it possible to offer the patient an acceptable life.The treatment of end-stage renal failure in patients with diabetes mellitus presents special problems as a result of the disseminated nature of the disease. As a result of experience in recent years (2,3,7,8,10,16,17) from the treatment of kidney insufficiency in this particular group of patients, diabetes mellitus is no longer considered a contraindication for active treatment of terminal uraemia in diabetics.The treatment consists of both dialysis and kidney transplantation. Nearly all the published reports on the treatment of terminal uraemia with haemodialysis in diabetic patients (2, 3, 8, 16) conclude that the treatment gives the patients an acceptable life; only one paper (7) is more sceptical.…”

mentioning

confidence: 99%

“…The treatment of end-stage renal failure in patients with diabetes mellitus presents special problems as a result of the disseminated nature of the disease. As a result of experience in recent years (2,3,7,8,10,16,17) from the treatment of kidney insufficiency in this particular group of patients, diabetes mellitus is no longer considered a contraindication for active treatment of terminal uraemia in diabetics.…”

mentioning

confidence: 99%

“…The treatment consists of both dialysis and kidney transplantation. Nearly all the published reports on the treatment of terminal uraemia with haemodialysis in diabetic patients (2,3,8,16) conclude that the treatment gives the patients an acceptable life; only one paper (7) is more sceptical. Three reports on kidney transplantation in diabetic patients with end-stage renal failure (8,10,17) find the results so satisfactory that the intention is to transplant diabetics on a par with patients not suffering from this disease.…”

mentioning

confidence: 99%

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The Treatment of End‐stage Renal Failure in Insulin‐dependent Diabetic Patients

Thayssen

Roed-Petersen

Nielsen

et al. 1977

Journal of Internal Medicine

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Twenty‐six insulin‐dependent patients with diabetes mellitus have been treated for end‐stage renal failure during a 5‐year period. The cause of this failure was diabetic nephropathy in 24 cases. Eleven patients were temporarily treated with diet alone for their uraemia; 23 patients, 7 of whom had previously been treated with diet alone, were treated with dialysis and 9 of these patients were later subjected to kidney transplantation. One patient received a kidney graft directly, while his uraemia was treated with diet alone. At the time of initiation of the treatment for renal insufficiency, the diabetes had lasted for 22 years and the kidney disease for 5 years (average values). Peritoneal dialysis presented no complications. The main problem with haemodialysis was difficulty with the arteriovenous shunt. The regulation of the diabetes caused problems in all 10 patients subjected to kidney grafts; all required increased doses of insulin. Infection and hypertension were prevalent among these patients, while rejection of the graft occured in only 2 cases. No definite changes were found in the cardiac status, retinal changes or BP during treatment. The average period of observation for all 26 patients was 10 months. The total mortality was 65%; approximately half of the deaths were due to cardiovascular causes and about 1/3 to infection. The cumulative survival after 3 years was 25% for all patients and 41% after 2 years for the graft recipients. The present investigation shows that both dialysis and kidney transplantation are possible in patients with diabetes mellitus and end‐stage renal failure. The goal of future treatment must therefore be kidney transplantation, as it makes it possible to offer the patient an acceptable life.

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Dialysis in Diabetics

Cited by 29 publications

References 13 publications

Diabetic Nephropathy

Diabetic Nephropathy

Management of Patients with Renal Failure Complicated by Cerebral Oedema

The Treatment of End‐stage Renal Failure in Insulin‐dependent Diabetic Patients

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