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

Abstract

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.