LONG-TERM FOLLOW-UP-STUDY OF 268 DIABETIC-PATIENTS UNDERGOING HEMODIALYSIS, WITH SPECIAL ATTENTION TO VISUAL-ACUITY AND HETEROGENEITY

We studied the long-term outcome of 268 patients suffering from diabet ic end-stage renal disease (DM-ESRD) treated with long-term haemodialy sis between 1978 and 1991, with special emphasis on visual acuity as w ell as the heterogeneity of DM-ESRD. The 50% patient survival on haemo dialysis was 60 months. Visual disturbances were found in 73.1% (392/5 36) of eyes at the start of haemodialysis. Chronological assessment of visual acuity demonstrated the stabilization of visual acuity and 87. 1% (364/418) of eyes were stable, 4.8% (20/418) were improved, and 8.1 % (34/418) were aggravated in the long term respectively. The change o f visual acuity was frequently seen in the short term, and rapid shift s of body fluid to correct overhydration induced abrupt changes of gly caemic control as well as retraction of macular oedema. Hence it might be one of the factors affecting rapid change of visual acuity in the short term. Meanwhile, long-term deterioration of visual acuity result ed from either hypertension unresponsive to medical treatment or poor glycaemic control. Some DM-ESRD patients had only background retinopat hy at the start of haemodialysis and these were likely to have the nep hrosclerotic glomerular lesion. They were old, not nephrotic and had a mild degree of diabetes during the predialysis stage. Thus, DM-ESRD p atients seem to have some heterogeneity in their clinical characterist ics, and old DM-ESRD patients with only background retinopathy have th e appearance of diabetic macroangiopathy rather than microangiopathy.