The Management of Terminal Renal Failure in Diabetic Patients by Regular Dialysis Therapy

Abstract

Ten diabetics, nine requiring insulin, were kept alive on peritoneal dialysis and haemodialysis for varying periods of time, with a mean suvival rate of 7 months only per patient. The management of the cardiovascular problems affecting the brain, eye, heart, and peripheral vessels far exceeded the difficulties in managing their diabetic state. Two patients were maintained on home dialysis, one with full sight, the other with partial sight. One patient received a combined renal and pancreatic transplant and required no insulin for 8 days, succumbing from a pulmonary embolus. Patients with diabetes will be accepted in the future for regular dialysis, particularly before severe protein restriction has taken place, and before hypertension has complicated their retinal problems.

Insulin and the Kidney

“…Reports of hemodialysis for diabetic nephropathy have been most dis appointing [138], Only 8 of 39 patients survived as long as 3 months in the series of C h a z a n et al [19], while 78% of the patients treated by G havam ian et al [48] had died within 1 year. Serious difficulties with hypoglycemia, clotted shunts, infection, congestive heart failure and muscle wasting occurred.…”

Dialysis and Transplantation of Diabetics in the United States

“…Of 340 patients in whom visual status was given, 111 (32.6%) had deterio ration of vision [3,4,[6][7][8]10,12,13,16,17,19]. There are no progressive studies to indicate the factors responsible for decrease in visual acuity, though the effect of heparin on the known tendency of diabetics to develop retinal hemorrhage is suspect.…”

“…A total of 96 out of 501 patients (19.2%) developed either myocardial infarcts or con gestive heart failure while undergoing MD [4,6,8,11,15,19,21]. A third manifestation of diabetic vasculopathy, cerebrovascular hem orrhage, or thrombosis was noted in about 1 in lOhemodialyzed diabetics [4,6,8,11,15,21].…”

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

“…Although other authors have suggested larger doses of intraperitoneal insulin with or without subcutaneous insulin, or subcutane ous insulin alone [16,17], in our experience the intraperitoneal dosage schedule, as de scribed, is very satisfactory. It is essential to take precautions to prevent post-dialysis hypoglycemia by omitting insulin from the last 4 exchanges when using the cycler or manual method of dialysis, or by adding glucose to the peritoneal cavity at the end of dialysis when the PDS machine is used.…”