Visual Function in Diabetic Patients Undergoing Dialysis: Comparison of Peritoneal and Hemodialysis

Abstract

A prospective, uncontrolled study was designed to evaluate the changes in visual efficiency among insulin-requiring diabetic patients undergoing peritoneal and hemodialysis. Of the 112 patients (63% adult onset and 37% juvenile onset diabetics) studied chronologically, 63% were treated with hemodialysis and 37% with peritoneal dialysis. The mean distribution of sex, age, observation period and initial visual function were the same in the peritoneal and hemodialysis subpopulations, but more juvenile onset diabetics were treated with peritoneal dialysis. Preservation of vision correlated well with overall blood pressure control in all dialysis groups. Loss of vision was independent of the dialysis modality, of glucose control, and of the type of onset of diabetes.

Managing the Diabetic with Renal Insufficiency

“…Before 1972, Shapiro et al reported 50% first year survival rates 210 for insulin-dependent diabetics undergoing hemodialysis. At present, these figures exceed 75% (40). The early experience with intermittent peritoneal dialysis in diabetic patients showed a mean one year survival of about 50%, with few centers reporting at the end of 2 years.…”

“…In a prospective study designed to evaluate the changes in visual function among Type I and Type II diabetic patients undergoing peritoneal dialysis and hemodialysis, our group observed a strong correlation between control of arterial hypertension and preservation of vision in both types of diabetes, regardless of dialysis modality (40). Among hemodialysis patients, Shapiro and Comty have ascribed the improved preservation of vision in insulin-dependent diabetic patients to normalization of blood pressure, improved diabetic control and nutrition (41).…”

Diabetic Nephropathy: Management of the end-stage patient

“…Regardless of the dialytic modality studied, retinopathy appears to progress in uremic diabetic patients (47). Although careful follow-up of blood pressure and avoidance of excessive heparinization, which can lead to vitreous hemorrhage, may lessen the complications of retinopathy, close and frequent ophthalmological follow-up is imperative.…”

Aggressive Ophthalmological Management in Diabetic End-Stage Renal Disease: A Study of 31 Consecutively Referred Patients

“…Clinicians estimate that 97% of ure mic diabetics will have background or proliferative reti Little information documents the course of eye disease in diabetics who are treated for uremia. In one study by Diaz-Buxo et al [5], visual function was assessed over a 7-year period only in dialysis patients, 26% of whom received laser photocoagulation and 59% of whom had stabilization and/or improvement in vision. Over a 2-year period, Ramsay et al [6] reported on the visual outcome of diabetics with end-stage renal disease, suggesting that kidney transplant recipients attain a distinct edge over patients on dialysis -vision improved or stabilized in 74% of the former versus 58% of the latter.…”

“…Over a 2-year period, Ramsay et al [6] reported on the visual outcome of diabetics with end-stage renal disease, suggesting that kidney transplant recipients attain a distinct edge over patients on dialysis -vision improved or stabilized in 74% of the former versus 58% of the latter. Since Ram say's [6] and Diaz-Buxo's [5] reports, aggressive ophthal mologic intervention now includes greatly improved vit rectomy methodology [7,8] as well as modifications in laser technique [9]. Consensus thinking holds that early intervention is important to preserve sight.…”