Hemodialysis in Type I and Type II Diabetic Patients with Endstage Renal Failure

  • Eberhard Ritz
  • Antony Raine
  • Daniel Cordonnier


In the early days of hemodialysis efforts to treat and rehabilitate uremic diabetics were largely unsuccessful [1] until dialysis procedures and volume control had become more effective. Although diabetics have a poorer outcome than non-diabetics, survival has improved progressively, e.g. in the US adjusted first year mortality decreasing from 46% in 1982 to 30% in 1992 [2], although long-term survival is still very unsatisfactory, e.g. at 5 years 45% in type I and 10% in type II diabetics according to a recent German multicenter study [3]. Nevertheless it is no longer justified to deny admission to renal replacement therapy to the diabetic patient [4].


Diabetic Patient Renal Replacement Therapy Dialysis Patient Endstage Renal Failure Nephrol Dial Transplant 
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  1. 1.
    Ghavamian M, Gutch CG, Kopp KF, Kolff WJ. The sad truth about hemodialysis in diabetic nephropathy. JAMA 1972; 222:1386–1389PubMedCrossRefGoogle Scholar
  2. 2.
    Brunner FP et al. Survival on renal replacement therapy: data from the EDTA registry. Nephrol Dial Transplant 1988; 1:109–122Google Scholar
  3. 3.
    Koch M, Kutkuhn B, Grabensee B, Ritz E. Apolipoprotein A, fibrinogen, age, and history of stroke are predictors of death in dialysed diabetic patients: a prospective study in 412 subjects. Nephrol Dial Transplant 1997; 12: 2603–2611PubMedCrossRefGoogle Scholar
  4. 4.
    Pirson Y. The diabetic patient with ESRD: how to select the modality of renal replacement. Nephrol Dial Transplant 1996; 11:1511–1514PubMedCrossRefGoogle Scholar
  5. 5.
    Annual Data Report. United States Renal Data System, April 1997Google Scholar
  6. 6.
    Lippert J, Ritz E, Schwarzbeck A, Schneider P. The rising tide of endstage renal faiulre from diabetic nephropathy type II — an epidemiological analysis. Nephrol Dial Transplant 1995; 10: 462–467PubMedGoogle Scholar
  7. 7.
    Raine AEG. Epidemiology, development and treatment of endstage renal failure in non-insulin dependent diabetics in Europe. Diabetologia 1993; 36:1099–1104PubMedCrossRefGoogle Scholar
  8. 8.
    Rodriguez JA, Clèries M, Vela E and Renal Registry Committee. Diabetic patients on renal replacement therapy: anqalysis of Catalan Registry Data. Nephrol Dial Transplant 1997; 12: 2501–2509PubMedCrossRefGoogle Scholar
  9. 9.
    Nineteenth Report of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) 1996 (Disney APS, ed.)Google Scholar
  10. 10.
    Cordonnier DJ, Zmirou D, Benhamou PY, Halimi S, Ledoux F, Guiserix J. Epidemiology, development and treatment of endstage renal failure in Type 2 (non-insulin-dependent) diabetes. The case of mainland France and of overseas French territories. Diabetolgia 1993; 36:1109–1112CrossRefGoogle Scholar
  11. 11.
    Cowie CC, Port FK, Wolfe RA, Savage PJ, Moll PP, Hawtome VM Disparities in incidence of diabetic end-stage renal disease according mto ravce and type of diabetes. N Engl J Med 1989; 321: 1074–1079PubMedCrossRefGoogle Scholar
  12. 12.
    Ritz E, Nowack R, Fliser D, Koch M, Tschöpe W. Type II diabetes: Is the renal risk adequately appreciated? Nephrol Dial Transplant 1991; 6: 679–682PubMedCrossRefGoogle Scholar
  13. 13.
    Catalano C, Postorino M, Kelly PJ, Fabrizi F, Emnia G, Goodship TH. Diabetes melliltus and renal replacement therapy in Italy: prevalence, main charcteristics and complications. Nephrol Dial Transplant 1990; 5:788–796PubMedCrossRefGoogle Scholar
  14. 14.
    Ritz E, Strumpf C, Katz F, Wing AJ, Quellhorst E. Hypertension and cardiovascular risk factors in hemodialysed diabetic patients. Hypertension 1985; 7: 118–125CrossRefGoogle Scholar
  15. 15.
    Koch M, Thomas B, Tschöpe W. Survival and predictors of death in dialysed diabetics. Diabetologia 1993; 36:1113–1117PubMedCrossRefGoogle Scholar
  16. 16.
    Majorca R, et al. A six year comparison of patient and technique survivals in CAPD and HD. Kidney Int 1988; 34: 518–524CrossRefGoogle Scholar
  17. 17.
    United States Renal Data System. Annual Data Report. Am J Kidn Dis 1991; 18: Suppl 2Google Scholar
  18. 18.
    Foley RN, Culleton BF, Parfrey PS, Harnett JD, Kent GM, Murray DC, Bare PE. Cardiac disease in diabetic endstage renal disease. Diabetologia 1997; 40: 1307–1312PubMedCrossRefGoogle Scholar
  19. 19.
    Kikkawa A, Arimura T, Haneda M, Nkshio T, Katsunori S, Yagisawa M, Shigeta Y. Current status of type II (non-insulin-dependent) diabetic subjects on dialysis therapy in Japan. Diabetologia 1993; 36:1105–1108PubMedCrossRefGoogle Scholar
  20. 20.
    Tschöpe W, Koch M, Thomas B, Ritz E. Serum lipids predict cardiac death in diabetic patients on maintenance hemodialysis. Nephrol 1992; 64: 354–358Google Scholar
  21. 21.
    Koch M, Kutkuhn B, Trenkwalder E, Bach D, Grabensee B, Dieplinger H, Kronenberg F. Apolipoprotein B, fibrinogen, HDL cholesterol, and apolipoprotein(a) phenotypes predict coronary artery disease in hemodialysis patients. J Am Soc Nephrol 1997; 8: 1889–1898PubMedGoogle Scholar
  22. 22.
    McMillan MA, Briggs JD, Junor BS. Outcome of renal replacement therapy in patients with diabetes mellitus. Bit Med J 1990; 301: 540–544CrossRefGoogle Scholar
  23. 23.
    Yu CC, W MS, W CH, Yang CW, Huang JY, Hong JJ, Chian CYF, Leu ML, Huang CC. Predialysis glycemic control is an independent predictor of clinical outcome in typoe II diabetics on continuous ambulatory peritoneal dialysis. Periton Dial Internat 1997; 17: 262–268Google Scholar
  24. 24.
    Wu MS, Yu CC, Wang CW, Wu CH, Haung JY, Hong JJ, Fan Chiang CY, Huang CC, Leu ML. Poor predialysis glycemic control is a predictor of mortality in type II diabetic patients on maintenance hemodialysis. Nephrol Dial Transplant 1997; 12:2105-PubMedCrossRefGoogle Scholar
  25. 25.
    Foley RN, Parfrey PS. Cardiac disease in the diabetic dialysis patient. Nephrol Dial Transplant (in press)Google Scholar
  26. 26.
    Fujisawa T, Ikegami H, Shen GG. Angiotensin I converting enzyme polymorphism is associated with myocardial infarction, but not with retinopathy or nephropathy, in NIDDM. Diabetes Care 1995; 18: 983–985PubMedCrossRefGoogle Scholar
  27. 27.
    DeFronzo Ra, Alvestrand A, Smith D, Hendler E, Waren J. Insulin resistance in uremia. J Clin Invest 1981; 67: 563–568PubMedCrossRefGoogle Scholar
  28. 28.
    Hörl WH, Haag-Weber M, Georgopoulos A, Block LH. The physicochemical characterization of a novel polypeptide present in uremic serum that inhibits the biological activity of polymorphonuclear cells. Proc Natl Acad Sci 1990; 87: 6353–6357PubMedCrossRefGoogle Scholar
  29. 29.
    Zuanetti G, Maggioni AP, Keane W, Ritz E. Nephrologists neglect administration of betablockers to dialysed diabetic patients. Nephrol Dial Transplant 1997; 12: 2497–2501PubMedCrossRefGoogle Scholar
  30. 30.
    Weinrauch LA, D’Elia JA, Healy RW. Asymptomatic coronary artery disease angiography in diabetic patients before renal transplantation. Ann Intern Med 1978; 88: 346–348PubMedCrossRefGoogle Scholar
  31. 31.
    Manske CL, Thomas W, Wang Y, Wilson RF. Screeding diabetic transplant candidates for coronary artery disease: Identification of a low risk subgroup. Kidney Int 1993; 44: 617–621PubMedCrossRefGoogle Scholar
  32. 32.
    Manske CL, Wang Y, Rector T, Wilson RF, White CW. Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure. Lancet 1992; 340: 998–1002PubMedCrossRefGoogle Scholar
  33. 33.
    Rinehart AL, Herzog CA, Collins AJ, Flack JM, Ma JZ, Opsahl JA. Greater risk of cardiac events after coronary angioplasty (PTCA) than bypass grafting (CABG) in chronic dialysis patients. J Am Soc Nephrol 1992; 3: 389(a)Google Scholar
  34. 34.
    Wizemann V, Kaufinann J, Kramer W. Effect of erythropoietin on ischemia tolerance in anemic hemodialysis patients with confirmed coronary artery disease. Nephron 1992; 62:161–165PubMedCrossRefGoogle Scholar
  35. 35.
    Uusitupa M et al. Relationship of blood pressure and left ventricular mass to serum insulin levels in newly diagnosed NIDDM (type II) and in non-diabetic subjects. Diabetes Res 1987; 4:19–25PubMedGoogle Scholar
  36. 36.
    Ritz E, Rufimann K, Rambausek M, Mall G, Schmidly M Dialysis hypotension — is it related to diastolic left ventricular malfunction? Nephrol Dial Transplant 1987; 2: 193–197Google Scholar
  37. 37.
    Ringe B, Braun F. Pancreas transplantation: where do we stand in Europe in 1997? Nephrol Dial Transplant 1997; 12: 1100–1104PubMedCrossRefGoogle Scholar
  38. 38.
    Rischen-Vos J, van der Woude FJ, Tegzess AM, Zwinderman AH, Gosszen HC, van den Akker PJ, van Es LA. Increased morbidity and mortality in patients with diabetes mellitus after kidney transplantation as compared with non-diabetic patients. Nephrol Dial Transplant 1992; 7: 433–437PubMedGoogle Scholar
  39. 39.
    Port FK, Wolfe RA, Mauger EA, Berlin DP, Jian K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA 1993; 270: 1339–1343PubMedCrossRefGoogle Scholar
  40. 40.
    Hirschl MM, Derfler K, Heinz G, Sunder-Plassmann G, Waldhäusl W. Longterm follow-up of renal transplantation in type I and type II diabetic patients. Clin Invest 1992; 70:917–921CrossRefGoogle Scholar
  41. 41.
    Borgel F, Benhamou PY, Zmirou D, Balducci F, Halimi S, Cordonnier A. Assessment of handicap in chronic dialysis diabetic patients (Uremidiab Study). Scand J Rehab Med 1992; 24: 203–208Google Scholar
  42. 42.
    Zmirou D, Benhamou PY, Cordonnier D, Borgel F, Balducci F, Papoz L, Haimi S. Diabetes mellitus prevalence among dialysis patients in France (Uremidiab Study). Nephrol Dial Transplant 1992; 7:1092–1097PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • Eberhard Ritz
    • 1
    • 2
  • Antony Raine
    • 1
    • 2
  • Daniel Cordonnier
    • 1
    • 2
  1. 1.Medizinische Klinik HeidelbergKlinikum der Universität HeidelbergGermany
  2. 2.Centre Hospitalier RégionalUniversitaire de GrenobleGrenobleFrance

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