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Clinical aspects of continuous ambulatory and continuous cyclic peritoneal dialysis in diabetic patients
J Rottembourg1, B Issad, M Allouache
1Department of Nephrology, Groupe Hospitalier Pitié-Salpétrière, Paris, France.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD) offer advantages for diabetic nephropathy patients. This study highlights their benefits and drawbacks, suggesting CAPD-CCPD as a preferred home dialysis method for young diabetics.
Area of Science:
- Nephrology
- Diabetology
- Cardiovascular Medicine
Background:
- End-stage renal diabetic nephropathy presents significant treatment challenges.
- High-risk patients often exhibit extrarenal complications, particularly vascular lesions.
Purpose of the Study:
- To evaluate the advantages and drawbacks of continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD) in patients with diabetic nephropathy.
- To assess the long-term outcomes and survival rates associated with CAPD-CCPD therapy.
Main Methods:
- A cohort of 81 patients with diabetic nephropathy were treated with CAPD-CCPD over 9 years.
- An intraperitoneal insulin injection technique was employed to manage blood glucose levels in CAPD patients.
- Actuarial survival and causes of death/transfer to hemodialysis were analyzed.
Main Results:
- Actuarial survival was 92% at 1 year and 50% at 4 years, significantly influenced by age.
- Cardiovascular events (myocardial infarction, stroke) were the primary causes of mortality.
- Technical complications led to transfer to hemodialysis; peritonitis occurred every 14 patient-months.
- Improved control of blood pressure, blood glucose, and visual status were noted advantages.
Conclusions:
- CAPD-CCPD demonstrates benefits in managing key parameters for diabetic nephropathy patients.
- Age is a critical factor influencing survival rates.
- CAPD-CCPD is recommended as the primary choice for young diabetic patients and as a preferential home dialysis technique.
Abstract:
The treatment of end-stage renal diabetic nephropathy remains a challenge. A large experience allows us to clearly outline the advantages and the drawbacks of continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD). Eighty-one patients, mean age 51.3 years, were treated over the last 9 years by CAPD-CCPD. Extrarenal complications, mainly vascular lesions, were present in this high-risk group of patients. The technique was modified in order to inject intraperitoneally, 4 times per day, insulin to control blood glucose level in CAPD patients. Actuarial survival was 92% at 1 year, 50% at 4 years mainly influenced by age: 85% survival at 2 years in 35 patients aged less than 50 years old and 62% at 2 years in 46 patients aged more than 50 years old. The main causes of death were of cardiovascular origin: myocardial infarction, stroke, atherosclerotic vasculopathy. The main causes of transfer to hemodialysis were due to technical complications. Peritonitis rate was one episode every 14 patient-months. Control of blood pressure, blood glucose levels, main biological parameters, and visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPD-CCPD is the technique of first choice in young diabetics and the preferential technique for home dialysis.