GASTROPARESIS IN DIABETICS ON CHRONIC DIALYSIS - CLINICAL AND LABORATORY ASSOCIATIONS AND PREDICTIVE FEATURES

Clinical and laboratory features and risk factors for diabetic gastrop aresis (DGP) were investigated in 226 diabetics on chronic dialysis; 1 06 subjects (43%) had DGP diagnosed by persistent vomiting improved wi th the use of prokinetic agents and 120 (control group) had no clinica l DGP. Type 1 diabetics had DGP more frequently than type 2 diabetics (70 vs. 37%). The DGP group had longer duration of diabetes (21 +/- 8 vs. 13 +/- 6 years), higher frequency of diabetic orthostatic hypotens ion (95 vs. 33%), enteropathy (49 vs. 5%), blindness (52 vs. 23%), myo cardial infarction (86 vs. 42%), extremity gangrene (54 vs. 27%) and c erebrovascular accidents (43 vs. 25%), lower serum albumin 32.3 +/- 3. 9 vs. 35.4 +/- 3.8 g/l), urea (24.0 +/- 5.5 vs. 25.5 +/- 5.5 mmol/l) a nd creatinine (710 +/- 210 vs. 820 +/- 220 mu mol/l), and higher serum TCO2 (20.9 +/- 3.1 vs. 19.8 +/- 2.7 mmol/l) than the control group (a ll differences significant at p +/- 0.004). Glycemic control was adequ ate in 24% of the DGP group subjects and 83% of the control subjects ( p < 0.001). Annual hospitalization rate was 49 +/- 48 days/patient in the DGP group and 16 +/- 27 days/patient in the control group (p < 0.0 01). Median patient survival was 24 +/- 2 months in the DGP group and 61 +/- 9 months in the control group (p < 0.0001). Logistic regression identified long duration of diabetes and poor glycemic control as ris k factors for DGP. In diabetics on dialysis, DGP is associated with hi gh frequency of other diabetic complications, low serum albumin and cr eatinine, and high morbidity and mortality. Efforts to improve glycemi c control in the hope of delaying DGP appear to be worthwhile.