Continuous Ambulatory Peritoneal Dialysis(CAPD) in Patients with Diabetic Nephropathy

Kim, Chan Duck; Baek, Mi Young; Kim, Jun Chul; Park, Sun Hee; Kim, Yong Lim; Cho, Dong Kyu

Abstract

OBJECTIVE
Diabetic nephropathy is one of leading causes of end stage renal disease(ESRD). The ability to control anemia and hypertension without sudden drastic body fluid changes was thought to favor CAPD over hemodialysis for the management of diabetic ESRD with severe cardiovascular disease. To assess survival and risk factors in diabetic end stage renal failure, clinical studies were carried out on the 68 cases on CAPD who had been treated from January 1988 to February 1997. Methods - The mean age was 55.5 years and the sex distribution was 43 males to 25 females. Mean CAPD duration was 16.4 months ranged from one to 68 months. Five patients had insulin-dependent dia- betes ; 63 had non-insulin-dependent diabetes. Mean duration of diabetes was 13.8 years. All patients used curl catheter. Blood glucose was controlled by oral hypoglycemics(n=17) or subcutaneous regular insulin(n=51). Results - The incidence of peritonitis was 1.1 episodes/patient-year and exit site infection was 0.3 episodes/patient-year. Other complications were lea- kage, catheter dislodgement, transient hypotension. Mean hospital stay was 48.6 days/patient-year. Patient survival rates at 1, 2, 3, and 4 years were 73, 51, 30, and 30%, respectively for diabetic CAPD patients and 92, 85, 72, and 68%, respectively for non-diabetic patients. Diabetic CAPD patients had significantly lower survival when compare to nondiabetics(p<0.01). Catheter survival rates were 85% at one year, and 42% at three years in diabetics. Catheter were removed in 19 cases and the causes were peritonitis(84.2%) and catheter obstruction and malfunction(15.8%). By the end of the study, 38.2% of the patients were still on CAPD, 44.19% had died, 17.6M had transferred to hemodialysis. Common cause of deaths were cachexia, CAPD peritonitis with sepsis, cerebrovascular accidents and cardiovascular complications.
CONCLUSION
Although diabetic CAPD patients had significantly lower survival compared to non-diabetics, CAPD seems a good renal replacement modality for patients with diabetic renal failure as yet.