Transplantation versus dialysis Therapy

Rb, Khauli; Dr, Steinmuller; Ac, Novick; Buszta, C; Goormastic, Marlene; Nakamoto, Satoru; Dg, Vidt; Magnusson, Magnus O.; Paganini, Emil P.; Mj, Schreiber

doi:10.1097/00007890-198605000-00009

Cited by 63 publications

(4 citation statements)

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“…Khauli ct al. [88,94] studied vascular disease performing coronary angiography be fore allocating patients to the transplantation program. They experienced significantly fewer deaths from heart failure than other series (3 in 48 patients) and these deaths occurred in cases with the most extensive degree of vascular heart disease.…”

Section: Results From Renal Transplantation In Insulin-dependent Diabmentioning

confidence: 99%

End-Stage Renal Failure in Diabetic Nephropathy: Pathophysiology and Treatment

Schmitz¹,

Hansen²,

Ørskov³

et al. 1985

Blood Purif

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Forty percent of patients with insulin-dependent diabetes will develop nephropathy during the course of their disease, thus being the most important single disorder leading to end-stage renal failure (ESRF). Intensive metabolic control delays onset of diabetic nephropathy, the first omen of which is appearance of subclinical albuminuria, also termed microalbuminuria. Moreover, it is now established that intensive treatment of hypertension reduces rate of decline in GFR and thus postpones ESRF.When uremia eventually sets in, a range of biochemical and endocrine abnormalities can be included among those characteristics of diabetes mellitus per se. These include elevated plas ma levels of growth hormone, glucagon and free fatty acids, which may participate in the uremic insulin resistance superimposed on the preexisting diabetic carbohydrate intolerance.Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are two established modalities of renal replacement therapy in diabetes mellitus. Controlled clinical trials for comparison of CAPD versus HD treatment of diabetics are, however, still needed. The survival rate is approximately 80 and 65-95 % in insulin-dependent diabetic patients at 1 year during treatment with HD and CAPD, respectively. However, it is general experience that diabetics on CAPD exhibit a glycemic control, superior to that attained during HD. It has not been proved that patient survival after cadaveric renal transplantation is better than on dialysis. The degree of vascular heart disease seems to be the major determinant for survival of kidney-transplanted diabetic patients.

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Section: Results From Renal Transplantation In Insulin-dependent Diabmentioning

confidence: 99%

End-Stage Renal Failure in Diabetic Nephropathy: Pathophysiology and Treatment

Schmitz¹,

Hansen²,

Ørskov³

et al. 1985

Blood Purif

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“…This subgroup had 1-and 2-year patient survival rates of 50 and 35% which was notably lower than survival in trans planted patients without evident heart disease. Two preli minary reports [18,19] provide evidence that diabetic patients with cardiovascular disease tend to do less well. ID -RD = Identical related donor; NID-RD = nonidentical related donor; CAD = cadaver donor; RD = related donors combined; HCMC = Hennepin County Medical Center; All = all transplants; MCHV= Medical Center Hospital of Vermont.…”

Section: Discussionmentioning

confidence: 99%

Renal Transplantation in Diabetes mellitus

Sussman

Foster

et al. 1986

Nephron

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We reviewed the recommendations and outcomes for all patients with diabetes mellitus and end-stage renal disease referred to the Medical Center Hospital of Vermont from 1971 through December 1983. During this period, we recommended transplantation in 53 of 73 patients evaluated. Thirty-two transplants were performed in 30 patients. Of the 30 patients, 10 had clinical vascular disease prior to transplantation, i.e., claudication, amputation, active angina, myocardial infarction, or stroke. Seven of the 10 had only claudication or amputation. These 10 patients showed a clear excess in graft failure and mortality. One- and 2- year graft survival was 37 and 13%; patient survival was 48 and 24%. By comparison, the 20 patients without evident vascular disease had 1- and 2- year graft survival rates of 83 and 75% and patient survival rates of 85% at both 1 and 2 years. The incidence of cardiovascular death in the group with vascular disease was 45% at 1 year and 63% at 2 years, as compared with none in the group without vascular disease. The high graft loss and mortality in this group after transplantation should be a major consideration when therapeutic alternatives are considered in diabetics with end-stage renal disease.

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“…This technology has been used most extensively in the evaluation of patients near or at endstage renal failure on dialysis for potential renal transplantation. Transplantation is the only definitive therapy for uraemia, and survival well beyond that expected on dialysis is the goal 128,129 . In the early days of renal transplantation, acute coronary syndromes in the early postoperative period were commonplace and patient death rates high (from cardiovascular disease and from overwhelming infection).…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Coronary Artery Disease in Patients With Renal Failure

Goldsmith

Covic

2001

Int J Clinical Practice

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SUMMARYCardiovascular disease is prevalent in patients with advanced renal failure or on dialysis treatment, and after renal transplantation. The risk factors for the cardiovascular problems are a mixture of conventional and novel ones. Inflammation and oxidation may be especially important in the acceleration of atherosclerosis in chronic renal failure. This article discusses these factors and gathers together the evidence for cardiovascular intervention and treatment in a group of patients whose overall mortality is high.

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Transplantation versus dialysis Therapy

Cited by 63 publications

References 0 publications

End-Stage Renal Failure in Diabetic Nephropathy: Pathophysiology and Treatment

End-Stage Renal Failure in Diabetic Nephropathy: Pathophysiology and Treatment

Renal Transplantation in Diabetes mellitus

Coronary Artery Disease in Patients With Renal Failure

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