Abstract
The number of uremic patients with diabetic nephropathy who come to require hemodialysis treatment has been increasing in recent years. However, problems with blood access have been one of the major difficulties in regular hemodialysis treatment for those patients.
In order to clarify the details of such difficulties in hemodialysis patients with diabetes, we studied the frequency and type of problems in 15 patients with and 15 without diabetic nephropathy on regular hemodialysis treatment in our hospital. We also studied the platelet function, blood viscosity and blood flow rate of arteriovenous fistulas suspected as contributing factors of thrombosis.
The following results were obtained: (1) The major blood access problem was obstruction due to thrombosis and the frequency of this difficulty was remarkably higher in diabetic than nondiabetic patients. Remedial surgery of blood access was required on every 19.4 months for a diabetic patient and every 113.5 months for a nondiabetic patient. (2) There were no significant differences in the platelet function or blood viscosity between diabetic and nondiabetic patients on hemodialysis. (3) In diabetic patients, the blood flow rate of arteriovenous fistulas was diminished significantly in the post hemodialysis period, particularly when changing from the supine to the sitting position.
From the above results, it is concluded that reduction of the arteriovenous blood flow rate after HD might be a major cause of blood access problems in diabetic patients.
