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CAPD and transplantation in diabetics
1Department of Nephrology, University of Düsseldorf, FRG.
Insights
Continuous Ambulatory Peritoneal Dialysis (CAPD) offers a safe and effective treatment for diabetic patients with end-stage renal failure, showing good clinical outcomes and survival rates.
Area of Science:
- Nephrology
- Diabetology
- Internal Medicine
Background:
- Diabetic end-stage renal failure presents significant treatment challenges.
- Continuous Ambulatory Peritoneal Dialysis (CAPD) is an option for these patients.
- Long-term outcomes of CAPD in diabetic ESRD patients require evaluation.
Purpose of the Study:
- To assess the safety and efficacy of CAPD in insulin-dependent diabetic patients with end-stage renal failure.
- To evaluate clinical and biological parameters, including transplantation outcomes.
- To determine the suitability of CAPD for diabetic patients awaiting or ineligible for transplantation.
Main Methods:
- Retrospective analysis of 33 insulin-dependent diabetic patients undergoing CAPD for up to 70 months.
- Monitoring of clinical parameters (hypertension, hemoglobin, HbA1c) and biological markers (serum protein, phosphate, calcium).
- Assessment of peritonitis rates and patient survival rates; evaluation of post-transplantation outcomes in 7 patients.
Main Results:
- Acceptable levels of serum protein, phosphate, and calcium were maintained.
- Improved hemoglobin levels, hypertension control, and reduced medication requirements were observed.
- Near-normal HbA1c levels were achieved with subcutaneous insulin; peritonitis rate was 1/18 patient-months; survival rates were 83% (1st year) and 62% (2nd year).
- No CAPD-related complications occurred in 7 transplanted patients; 6 had successful graft function.
Conclusions:
- CAPD demonstrates good control of hypertension, blood glucose, and anemia in diabetic ESRD patients.
- The method avoids fluctuating fluid volumes, making it suitable for this population.
- CAPD is considered an optimal treatment for diabetic patients awaiting transplantation or those unsuitable for it.
Abstract:
Treatment of diabetics with end-stage renal failure is still a hazard. We report on 33 insulin-dependent diabetic patients who were treated with CAPD over a period of up to 70 months. Seven of them have been transplanted. The evaluation of the clinical and biological parameters serum protein, phosphate, calcium, revealed acceptable values. Hemoglobin rose during the treatment period. Hypertension improved and medication was reduced. HbAlc levels were near normal with subcutaneous application of insulin. Peritonitis rate was 1/18 patient-months. Survival rate was comparable with other centers with 83% in the first and 62% in the second year. In 7 patients that have been transplanted no CAPD-related problems arose after transplantation. 6 of them are still doing well; one returned to CAPD because of graft failure. In conclusion, because of good control of hypertension, blood glucose and anemia and the avoidance of fluctuating volumes, we think CAPD to be the best method for diabetics awaiting transplantation and for those that cannot be transplanted.