[Treatment of chronic kidney failure in diabetes mellitus]

27 patients suffering from end stage diabetic renal failure were treated by hemodialysis (HD) [8], continuous ambulatory peritoneal dialysis (CAPD) [13] or kidney allotransplantation after previous dialysis (KT) [13]. The mean age of the patients was 39.8 +/- 9.8, 44.8 +/- 11.3 and 33.8 +/- 5.7 for HD, CAPD and KT groups respectively. The cumulative patient survival after 1 and 2 years of treatment was 24%/0%, 56%/0% and 70%/50% for HD, CAPD and KT treatment. The cumulative allotransplant survival amounted to 40% after 1 year and to 20% after 2 and 3 years. Causes of death included cardiovascular complications in 7 patients, especially during HD treatment; infections occurred in 6 patients during CAPD treatment and after kidney allografting. Hypertension persisted during HD treatment and disappeared in 1/3 of the patients after KT. Nonlethal cardiovascular problems were observed during all treatment regimens and were more prominent in HD patients. In 2 patients, 3 amputations of the legs had to be performed after KT. Visual power deteriorated in more than half of the patients on HD and in one third during CAPD; it remained stable in half of the patients after KT. Neuropathy deteriorated during HD, was stable during CAPD and improved after KT. Rehabilitation was better during CAPD or after KT than during HD. The results of kidney replacement therapy in diabetics are worse than in non diabetic patients due to extrarenal organ damage. Early renal transplantation might prove to ameliorate this situation.