VASCULAR-DISEASE IN TYPE-II DIABETES - PROGRESSION BEFORE AND AFTER COMMENCING HEMODIALYSIS

In 20 nephropathic type II-diabetic patients (nine women, 11 men, mean age 56 +/- 7 years) we compared the progression of macroangiopathic d amages and the incidence rates of angiopathic complications during the pre-dialysis phase (mean observation period 70 +/- 26 months) and aft er start of dialysis treatment (observation period 29 +/- 21 months). The following parameters were measured at 2-month intervals: HbA1c, se rum cholesterol and triglycerides, systolic and diastolic blood pressu re and bodyweight. A fundoscopy, resting electrocardiogram, carotid Du plex sonography and Doppler sonographic investigations of the lower ex tremities were performed yearly. In special cases a thallium scintigra phy and/ or coronary angiography were also performed. The prevalence o f all cerebrovascular damages increased from 5% at the begin of the st udy 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 a t the start of dialysis treatment, and in 95% patients at the end of o bservation period. During this time the prevalence of myocardial infar ction increased from 5 to 25% and at least to 60% at the end of the st udy. Peripheral vascular disease was be observed in 20% of the patient s 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 sam e 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 v s 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 infarct ions) 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 myo cardial infarction was significantly (P<0.05) higher during the haemod ialysis period. In conclusion, the progression of macroangiopathic dis eases in type II diabetic patients is approximately the same during th e pre-dialysis and dialysis phase, but the incidence rates of the seve re macroangiopathic complications stroke and myocardial infarction are significantly higher during the period of haemodialysis. This increas e can be explained by the typical dialysis-induced effects on the hear t and the intravascular volume.