Continuous ambulatory peritoneal dialysis in diabetic patients. The relationship of hypertension to retinopathy and cardiovascular complications.

Abstract

From August 1978 to December 1983, 51 insulin-dependent diabetic patients with end-stage renal disease were selected for treatment by continuous ambulatory peritoneal dialysis. There were 27 male and 24 female patients, with a mean age of 52.3 +/- 13.5 years. Forty-five patients dialyzed themselves by continuous ambulatory peritoneal dialysis and six were treated by continuous cyclic peritoneal dialysis. All patients were treated at home. The cumulative duration of treatment was 65.6 patient-years; 14 patients were dialyzed for at least 24 months. Extrarenal complications were frequent at start of continuous ambulatory peritoneal dialysis, including hypertension in 48 patients, proliferative retinopathy in 50, and cardiovascular complications in 30. Age appeared to be the major risk factor, with success rates at 2 years of 78% in patients under age 50 years and only 50% in patients over age 50. The main cause of death was vascular and the main cause of transfer to other therapeutic modalities was abdominal complications or malnutrition or both. Excellent control of blood pressure, uremia, and blood glucose levels was obtained on a daily program of four exchanges. Improvement in visual status was frequently observed, mainly in the young population. In patients with juvenile diabetes, continuous ambulatory peritoneal dialysis should be part of an integrated program with transplantation, while in the elderly, the method offers a unique opportunity for them to treat themselves at home.