Continuous ambulatory peritoneal dialysis (CAPD) in diabetic patients with end-stage renal failure in Hong Kong

The authors' experience in managing 17 diabetic patients among their first 100 consecutive patients treated with continuous ambulatory peritoneal dialysis (CAPD) was reviewed. The diabetics were significantly older than the non-diabetics, but their biochemistry was comparable to that of the non-diabetics. With three exchanges a day, the requirement for antihypertensives was high (60%). Exit-site infection occurred at a rate of one episode per 9.7 patient-months, and the frequency of peritonitis averaged one episode per 9.4 patient-months; the main culprit was Staphylococcus pyogenes. Rehabilitation was good because the patients had to finance their treatment. In spite of old age, 23% worked full-time. There was no progressive increase in serum cholesterol or triglycerides. Glycemic control was good and was comparable whether the patients were given insulin subcutaneously or intraperitoneally. There was a highly significant (p less than 0.001) positive correlation between fasting blood glucose levels and HbA1 concentrations. Fasting blood glucose concentrations did not correlate with either serum cholesterol or triglyceride concentrations. Diabetic retinopathy progressed in five patients, to the point that their vision was severely impaired. There was no relationship between the degree of glycemic control and progression of diabetic retinopathy. Two patients died of cardiovascular causes, but there were no peritonitis-related deaths. Cummulative patient survival at 2 years was 86%, and the corresponding technique survival, 100%.