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[Clinical aspects of continuous ambulatory peritoneal dialysis in diabetics]
J Rottembourg1, B Issad, M Allouache
1Service de Néphrologie, Groupe hospitalier Pitié-Salpêtrière, Paris.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) offers benefits for diabetic nephropathy patients, including good glucose control. However, cardiovascular issues and technical complications remain significant challenges.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Context:
- End-stage renal diabetic nephropathy presents treatment challenges.
- Continuous ambulatory peritoneal dialysis (CAPD) is a potential treatment option.
- Patients with diabetic nephropathy often have high-risk extrarenal complications, particularly vascular lesions.
Purpose:
- To outline the advantages and drawbacks of CAPD in treating end-stage renal diabetic nephropathy.
- To assess the efficacy of intraperitoneal insulin administration for glucose control.
- To evaluate survival rates and causes of mortality in patients undergoing CAPD.
Summary:
- 81 patients with end-stage renal diabetic nephropathy were treated with CAPD-CCPD over nine years.
- Intraperitoneal insulin was administered to manage blood glucose levels.
- Actuarial survival was 92% at one year and 50% at four years, influenced by age. Cardiovascular events were the primary cause of death.
- Peritonitis occurred once every 14 months. CAPD demonstrated satisfactory control of blood pressure, glucose, and biological parameters.
- Peripheral vascular disease was not affected by CAPD. Technical complications led to treatment transfers.
Impact:
- CAPD can be a primary choice for young diabetics awaiting transplantation and a reference for home dialysis.
- The study highlights the importance of managing cardiovascular risk in this patient population.
- Intraperitoneal insulin delivery shows promise for glycemic control in CAPD patients.
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). 81 patients, mean age 51.3 years, were treated over the past nine years by CAPD-CCPD. Extrarenal complications, mainly vascular lesions, account for qualifying these patients as a high risk population. The technique was modified in order to inject insulin intraperitoneally, four times per day, to control blood glucose level. Peripheral vascular disease was prospectively studied in 19 patients. Actuarial survival was 92% at one year, 50% at four years mainly influenced by age: 85% survival at two years in 35 patients aged less than 50 years and 62% at two years in 46 patients aged more than 50 years. The main causes of death were of cardiovascular origin: arteritis, myocardial infarction, stroke. The main causes for transfer to an alternative method of treatment were technical complications. Peritonitis rate was one episode ever 14 months. Satisfactory control of blood pressure, blood glucose levels, main biological parameters, visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPD can be the technique of first choice in young diabetics awaiting a kidney transplant and the reference technique for home dialysis.