Visual Function in Diabetic Patients Undergoing Dialysis: Comparison of Peritoneal and Hemodialysis

Ja, Diaz-Buxo; Wp, Burgess; Greenman, M.; Jt, Chandler; Cd, Farmer; Pj, Walker

doi:10.1177/039139888400700506

Cited by 31 publications

(10 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Before 1972, Shapiro et al reported 50% first year survival rates 210 for insulin-dependent diabetics undergoing hemodialysis. At present, these figures exceed 75% (40). The early experience with intermittent peritoneal dialysis in diabetic patients showed a mean one year survival of about 50%, with few centers reporting at the end of 2 years.…”

Section: Therapy For Esrdmentioning

confidence: 85%

“…In a prospective study designed to evaluate the changes in visual function among Type I and Type II diabetic patients undergoing peritoneal dialysis and hemodialysis, our group observed a strong correlation between control of arterial hypertension and preservation of vision in both types of diabetes, regardless of dialysis modality (40). Among hemodialysis patients, Shapiro and Comty have ascribed the improved preservation of vision in insulin-dependent diabetic patients to normalization of blood pressure, improved diabetic control and nutrition (41).…”

Section: Progression Of Retinopathymentioning

confidence: 99%

See 1 more Smart Citation

Managing the Diabetic with Renal Insufficiency

Díaz-Buxó

1986

Int J Artif Organs

View full text Add to dashboard Cite

Diabetic nephropathy is responsible for the largest increase in new patients accepted for renal replacement therapy in industrialized countries (1). In Europe, the proportion of new dialysis patients who are diabetic has increased from less than 0.5% in 1972 to 7.3% in 1981 (2). In the U.S., about 3,200 diabetics reach end-stage renal disease (ESRD) each year, representing 20-25% of all new ESRD patients (3).Despite progress in dialysis the diabetic patient remains a formidable challange. ESRD develops pari passu with other complications that ultimately limit the quality of life. As our foremost goal should be to prevent all the complications of diabetes, the recent advances in diabetic nephropathy, retinopathy and neuropathy deserve our attention. PROGRESSION OF NEPHROPATHYThe role of arterial hypertension. Mogensen has thoroughly reviewed the relationship between diabetic nephropathy and arterial hypertension and called attention to its complexity and need for systematic evaluation (4,5). Complicating the analysis of this relationship is the frequent occurrence of both hypertension and diabetes in the general population and differences between Type I and Type II diabetics (body weight, age, incidence of hypertension, presence or absence of autonomic neuropathy and control of glycemia). The different stage of diabetic nephropathy and their characteristic renal hemodynamics must also be considered (5).A wealth of clinical data is being accumulated showing amelioration in the rate of decline of glomerular filtration rate GFR or protein excretion when blood pressure is lowed (6-13). A recent prospective, longitudinal and cross-sectional study showed a strong correlation between arterial blood pressure, urinary albumin excretion, and renal hemodynamics. The changes suggested a continuum of abnormalities, with distinct stages in the development of diabetic nephropathy (14).Parring et al have studied the effects of long-term, ag-The International Journal Of Artificial Organs I Vol. 9 no. 4, 1986 I p.p. 207-212 gressive antihypertensive therapy on GFR and albiminuria in young Type I patients (13). Their results suggest that prolonged reduction of blood pressure to near normal reduces the rate of decline of GFR and albuminuria. The role of glycemic control. The experimental diabetic rat model and experience with human renal transplantation have provided data suggesting that diabetic nephropathy is the result of hyperglycemia (15). Strict metabolic control with insulin prevents the thickening of the glomerular basement membrane (GBM), the increase in mesangial volume, the increases in GFR, and the onset of albuminuria (16,17). More impressive has been the reversal of renal diabetic changes in rats after pancreatic islet transplantation (18-22). The mesangial changes were reversed, glomerular volume diminished and albumin excretion returned to normal. The GBM, however, remained abnormally thickened.When the human non-diabetic kidney is transplanted into a diabetic host, the characteristic mesangial and GBM changes occ...

show abstract

Section: Therapy For Esrdmentioning

confidence: 85%

Section: Progression Of Retinopathymentioning

confidence: 99%

Managing the Diabetic with Renal Insufficiency

Díaz-Buxó

1986

Int J Artif Organs

View full text Add to dashboard Cite

show abstract

“…Regardless of the dialytic modality studied, retinopathy appears to progress in uremic diabetic patients (47). Although careful follow-up of blood pressure and avoidance of excessive heparinization, which can lead to vitreous hemorrhage, may lessen the complications of retinopathy, close and frequent ophthalmological follow-up is imperative.…”

Section: Progression To Esrd and Choice Of Uremia Therapy-mentioning

confidence: 99%

Diabetic Nephropathy: Management of the end-stage patient

Markell

Friedman

1992

Diabetes Care

View full text Add to dashboard Cite

Diabetic nephropathy is currently the leading cause of new patients requiring dialysis in the United States. Management of the diabetic patient with ESRD is complicated by the frequent coexistence of complications affecting other organ systems, including retinopathy, cardiovascular disease, peripheral neuropathy, or autonomic neuropathy, manifested as gastroparesis, diarrhea or obstipation, cystopathy, or orthostatic hypotension. Associated clinical syndromes must be followed and treated, if possible, while preparing the patient to receive renal replacement therapy. Both the clinical condition and the psychosocial environment are key factors in choice of ESRD therapy for an individual patient. Rehabilitation data are best for patients who undergo kidney transplantation, but these data are confounded by the fact that the healthiest patients are referred for this treatment modality. Living, related kidney transplant is the preferred initial choice for the diabetic patient with kidney disease. At most centers, both in the United States and abroad, the cadaveric transplant is the second choice for uremia therapy. At the appropriate institution, the patient with type I diabetes may also be considered for a simultaneous cadaveric pancreas transplant. While awaiting cadaveric transplantation, or if contraindication to transplantation is present (chronic infection, recent malignancy, or severe cardiac disease), diabetic patients with severe impairment of the glomerular filtration rate (less than 10-15 ml/min) are referred for vascular access placement and/or insertion of a peritoneal catheter. The decision regarding the choice of CAPD vs. hemodialysis must be made on an individual basis. Rehabilitation and survival data for these therapies are similar, although technique survival rates for CAPD decline dramatically as time progresses because of infectious complications. In-center hemodialysis has the worst survival and rehabilitation profile, but the sickest, most debilitated patients with the highest number of comorbid conditions tend to be referred for that therapeutic modality. Most studies of rehabilitation were performed before use of recombinant human erythropoietin, and comparison between ESRD treatment modalities will have to be reevaluated now that the drug is routinely used.

show abstract

“…Clinicians estimate that 97% of ure mic diabetics will have background or proliferative reti Little information documents the course of eye disease in diabetics who are treated for uremia. In one study by Diaz-Buxo et al [5], visual function was assessed over a 7-year period only in dialysis patients, 26% of whom received laser photocoagulation and 59% of whom had stabilization and/or improvement in vision. Over a 2-year period, Ramsay et al [6] reported on the visual outcome of diabetics with end-stage renal disease, suggesting that kidney transplant recipients attain a distinct edge over patients on dialysis -vision improved or stabilized in 74% of the former versus 58% of the latter.…”

Section: Introductionmentioning

confidence: 99%

“…Over a 2-year period, Ramsay et al [6] reported on the visual outcome of diabetics with end-stage renal disease, suggesting that kidney transplant recipients attain a distinct edge over patients on dialysis -vision improved or stabilized in 74% of the former versus 58% of the latter. Since Ram say's [6] and Diaz-Buxo's [5] reports, aggressive ophthal mologic intervention now includes greatly improved vit rectomy methodology [7,8] as well as modifications in laser technique [9]. Consensus thinking holds that early intervention is important to preserve sight.…”

Section: Introductionmentioning

confidence: 99%

Aggressive Ophthalmological Management in Diabetic End-Stage Renal Disease: A Study of 31 Consecutively Referred Patients

Berman

Friedman²,

Lundin³

1992

Am J Nephrol

View full text Add to dashboard Cite

We prospectively followed the course of eye disease in patients with diabetic end-stage nephropathy from the time of initial referral by the renal unit. A total of 31 patients (62 eyes) – 9 of whom had functioning renal transplants and 22 of whom were on maintenance dialysis – were consecutively evaluated for 6-24 months (mean follow-up of 18 months). Visual acuity and diabetic retinopathy stabilized or improved in all 18 eyes of the transplant patients and in 41 of 44 (93%) eyes of the dialysis patients. When first evaluated, economically useful vision (20/200 or better) was present in 11 of 18 (61 %) eyes in the transplant group and in 25 of 44 (57%) eyes in the dialysis group. At the most recent evaluation, economically useful vision was present in 13 of 18 eyes (72%) in the transplant group versus 28 of 44 eyes (64%) in the dialysis group. Ambulatory vision (counting fingers or better) was present in 15 of 18 eyes (83%) in the transplant group versus 37 of 44 eyes (84%) in the dialysis group.

show abstract

Visual Function in Diabetic Patients Undergoing Dialysis: Comparison of Peritoneal and Hemodialysis

Cited by 31 publications

References 4 publications

Managing the Diabetic with Renal Insufficiency

Managing the Diabetic with Renal Insufficiency

Diabetic Nephropathy: Management of the end-stage patient

Aggressive Ophthalmological Management in Diabetic End-Stage Renal Disease: A Study of 31 Consecutively Referred Patients

Contact Info

Product

Resources

About