[CAPD (continuous ambulatory peritoneal dialysis) in diabetic nephropathy: overview and general practice in the Lainz...

While there is progress in management of newly-diagnosed diabetic patients, treatment of diabetes and prevention of comorbid conditions, nephrologists are progressively confronted with the picture of fully established micro- and macrovascular disease. Experience with CAPD in patients with diabetes mellitus in the hospital Vienna-Lainz from 1982 to 8/1999 was analyzed and outcome data are presented. During this period 139 patients were treated with CAPD as primary renal replacement therapy, 41 with diabetes Type 1 and 47 with diabetes Type 2. Survival rate after 10 years of treatment (including transplantation and change to hemodialysis due to technical failure of CAPD) was 50% in type 1 diabetes and 8% in type 2 diabetes. In 73% of patients with type 1 diabetes a kidney or kidney-pancreas transplantation was performed. In contrast, only 11% of type 2 diabetic patients were eligible for kidney transplantation. These long-term data implicate further attempts in reducing the incidence of diabetic nephropathy and later on renal failure. Furthermore, screening and aggressive treatment for atherosclerotic complications are necessary to improve the prognosis in this patient cohort.