Non-diabetic Chronic Renal Failure Patients Research Articles

Carotid artery lesions in patients with nondiabetic chronic renal failure

Atherosclerotic complications are the leading cause of death in chronic renal failure (CRF) patients. Therefore, we wished to investigate the prevalence of carotid artery lesions (CALs) in these subjects. Two groups were evaluated by high-resolution echo Doppler: group 1 included 103 patients (68 males and 35 females) affected by nonnephrotic CRF and group 2 included 100 control subjects (60 males and 40 females). The prevalence of hypertension was 84% in both groups. The exclusion criteria included diabetes mellitus and symptoms of cerebrovascular disease. In the two groups we evaluated clinical history, physical examination, total cholesterol, triglycerides, fibrinogen, blood cell counts, blood urea nitrogen, creatinine, 24-hour proteinuria, and urine analysis. In group 1 patients the following lipid profile parameters were also evaluated: low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, lipoprotein(a), ApoAI, ApoAII, and ApoB. Group 1 had higher triglycerides and fibrinogen than group 2. A lower body mass index was found in group 1 than in group 2. The prevalence of CALs was significantly higher in the CRF patients than in the control subjects (62% v 47%; P = 0.04). The difference between the two groups was more striking among normotensive patients (62% v 19%; P = 0.03). All CRF patients affected by peripheral arterial disease and 86% of those having coronary artery disease had associated CALs. In CRF patients the severity of CALs was positively correlated to age, white blood cell count, triglycerides, and fibrinogen. Nondiabetic CRF patients have a higher prevalence of carotid artery lesions than control subjects. Several factors besides hypertension, including lipids, blood coagulation, and leukocytes, could contribute to the accelerated atherosclerosis of CRF patients.

Current thinking on the management of the uremic diabetic.

BOUT HALF of all type-1 diabetics, and an undefined but lesser proportion of type-II diabetics, will develop chronic renal failure (CRF). Diabetics constitute about one-fourth of end-stage renal disease patients in the United States, and a lesser but steadily increasing proportion (7.3% in 1981) in Europe.’ In general it has been found that diabetics suffer inordinately high morbidity and mortality compared to non-diabetic CRF patients. Data from the European Dialysis and Transplant Association Registry found only 70% one-year, and 28% five-year survival of diabetic CRF patients, roughly equivalent to the survival of nondiabetics 20 to 30 years older. The costs in human terms are enormous, and are reflected in dollar expense as well: we examined the first-year costs of transplanting 30 type-1 diabetics at our center and found that hospital charges were one-third higher for diabetics compared to a group of non-diabetic recipients.2 We will discuss aspects of treating the diabetic with advanced nephropathy that we feel are of importance in optimizing survival and rehabilitation. It is our strongly held opinion that effective application of currently available modalities offers much more to the diabetic patient than past statistics might indicate.