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Exp Clin Endocrinol Diabetes 1985; 85(1): 105-112
DOI: 10.1055/s-0029-1210426
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© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Clinical Course in Insulin-Dependent Diabetics Undergoing Hemodialysis*

E. Zander, B. Schulz, R. Beckert1) , Ingetraud Seidlein1)
  • Central Institute of Diabetes “Gerhardt Katsch” (Director: OMR Prof. Dr. sc. med. H. Bibergeil), I. Clinical Department (Director: OMR Prof. Dr. sc. med. B. Schulz), Karlsburg/GDR
* Dedicated to Professor H. Bibergeil on the Occassion of his 60th Birthday. 1) Ernst-Moritz-Arndt-University of Greifswald, GDR.
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Publication History

1984

Publication Date:
16 July 2009 (online)

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Summary

Nephropathy continues to be the most serious complication in type I-diabetics.

When we started chronic hemodialysis in these patients 15 years ago survival figures were poor. Later on the survival rate for diabetics undergoing hemodialysis has improved progressively. The aim of this report was to present our own experience in hemodialysis treatment of insulin-dependent diabetics.

The cumulative survival rate of 46 insulin-dependent diabetics undergoing hemodialysis has increased progressively and now amounts to 70% after one year, and 50% after two years of treatment.

At the same time we could attain a certain improvement of metabolic control.

Nutrition has also been improved, as indicated by increased transferrin (p < 0.05) and stable serum protein levels. Systolic blood pressure control became better (p < 0.05) but, a fluid overload was still present. Here, further improvements are necessary to increase the survival rate. Therefore, the survival of diabetic patients with hemodialysis may be approaching that of non-diabetics. In some patients retinopathy was improved after one year of treatment.

Despite a better prognosis for survival in diabetics treated by chronic hemodialysis we suggest that the successful renal transplantation should be the treatment of choice in patients suffering from diabetic nephropathy.

In general, hemodialysis and renal transplantation should be started earlier than hitherto, i.e. already at creatinine levels of about 600 μmol/1, and at urea levels of 30mmol/l.

Strict metabolic and blood pressure control, as well as early laser coagulation therapy of retinopathy should be instituted for patients with creatine levels above 200 μmol/1, in close cooperation of a diabetologist, nephrologist, and ophthalmologist. This will be our future therapeutic strategy for these patients.

Key words

Type I-diabetics - Diabetic nephropathy - Hemodialysis - Metabolic control - Survival rate