Vascular disease in type II diabetes: Progression before and after commencing haemodialysis

Abstract

Summary: In 20 nephropathic type II‐diabetic patients (nine women, 11 men, mean age 56 ± 7 years) we compared the progression of macroangiopathic damages and the incidence rates of angiopathic complications during the pre‐dialysis phase (mean observation period 70 ± 26 months) and after start of dialysis treatment (observation period 29 ± 21 months). the following parameters were measured at 2‐ month intervals: HbA1c, serum cholesterol and triglycerides, systolic and diastolic blood pressure and bodyweight. A fundoscopy, resting electrocardiogram, carotid Duplex sonography and Doppler sonographic investigations of the lower extremities were performed yearly. In special cases a thallium scintigraphy and/ or coronary angiography were also performed. the prevalence of all cerebrovascular damages increased from 5% at the begin of the study to 50% at the start of haemodialysis and to 70% at the end of the study. During the same period the prevalence of stroke increased from 0 to 10% and to 50%, respectively. Coronary heart disease was present in 40% of patients at the beginning of the study, in 80% of patients at the start of dialysis treatment, and in 95% patients at the end of observation period. During this time the prevalence of myocardial infarction increased from 5 to 25% and at least to 60% at the end of the study. Peripheral vascular disease was be observed in 20% of the patients at the time of entry into study, in 65% of patients at the start of haemodialysis and 85% patients at the end of the study. During the same time the prevalence of amputations of the lower legs increased from 10 to 15% and to 35%, respectively. the incidence of complications in both observation periods (pre‐dialysis and dialysis phase) was: 0.09 vs 0.08 for cerebrovascular damages (0.02 vs 0.16 for strokes), 0.08 vs 0.06 for cardiovascular diseases (0.04 vs 0.14 for myocardial infarctions) and 0.09 vs 0.08 for peripheral vascular diseases (0.01 vs 0.08 for amputations). the increase in the incidence rate of stroke and myocardial infarction was significantly (P<0.05) higher during the haemodialysis period. In conclusion, the progression of macroangiopathic diseases in type II diabetic patients is approximately the same during the pre‐dialysis and dialysis phase, but the incidence rates of the severe macroangiopathic complications stroke and myocardial infarction are significantly higher during the period of haemodialysis. This increase can be explained by the typical dialysis‐induced effects on the heart and the intravascular volume.