Short-term outcome of diabetic patients in renal replacement therapy

Background. Diabetic nephropathy or diabetes-related nephropathies represen ts one of the most relevant causes of renal failure in recent years. This c omplex pathological picture becomes particularly severe as time elapses and after starting renal replacement therapy (RRT). Methods. In an attempt to investigate the evolution of the major clinical f eatures, a retrospective study was carried out on a cohort of 76 diabetic p atients on RRT. Sixty-five have been treated by haemodialysis (HD) and 11 b y peritoneal dialysis (CAPD), for at least 1 year. In these patients change in modality of treatment, metabolic control, cardiovascular, and opthalmol ogical complications, peripheral neuropathy, state of vascular access, and intradialytic complications were surveyed at initiation and after I year of treatment. A modified Karnofski's score was utilized, to evaluate the degr ee of rehabilitation. The comparison of prevalence was evaluated, using Stu dent's t-test for paired samples. Results. After 1 year, Il patients on CAPD remained on the same type of tre atment. Out of 65 patients on standard bicarbonate HD, 11 were moved to ace tate free biofiltration, two to paired filtration dialysis and one to haemo filtration. A worsening in arrhythmias was recorded with an increased preva lence from 25.0 to 35.0% (n.s.), and one more patient (15 vs 16 and 19 vs 2 0 respectively) experienced ischaemic cardiomyopathy and cerebrovascular in sufficiency. Hypertension showed a significant improvement (72 vs 42, P<0.0 1). Nausea and vomiting, hypotensive episodes, and muscular cramps were mor e frequently observed. A worsening in patient's welfare was also recorded b ut without statistical significance. Conclusions. This clinical evaluation even if retrospective and lasting 1 y ear, may suggest that RRT does not per se represent a cause of the developm ent and progression of the major complications related to diabetic disease.