1985 Volume 18 Issue 3 Pages 323-329
The outcome for diabetic patients on dialysis has been poor. Early death (within one year) occurs frequently. Therefore we studied the relationship between the effects of dialysis on the prognosis and the clinical findings prior to the treatment.
Age, sex, types of diabetes mellitus, clinical and laboratory findings of uremia, and glucose and lipid metabolism were analyzed in 45 cases. Moreover, the effect of different modes of dialysis (hemofiltration [HF], and hemodialysis [HD]) on glucose and lipid metabolism were examined in 9 cases.
(1) Laboratory and clinical findings at the commencement of dialysis vs. prognosis:
The first group, consisting of 10 cases (survival for less than 1 year), showed significantly high BUN levels (145±48mg/dl, p<0.05) low creatinine levels (10.9±2.5mg/dl, p<0.05) compared with the second group that consisted of 35 cases (survival for more 1 year). Fasting blood sugar levels of the first group were significantly higher (251±219mg/dl, p<0.02) than those of the second group. Serum triglyceride levels were significantly high (239±78mg/dl, p<0.01) in the first group. In the first group, cardio and cerebrovascular complications were observed in 50% and 80% respectively, and were significantly higher than in the second group. Vascular death occurred in 77% of the first group and in 22.2% of the second group.
Factors influencing the prognosis were a high triglyceride level, abnormal glucose metabolism, and the complication of macroangiopathy.
(2) Effects of HD and HF:
There was no difference in the insulinogenic index at 30 nin of Oral-GTT between the two groups. ∑IRI/∑BS was 42.0±21.5μu/mg on HF and 29.8±23.4μu/mg on HD. A significant (p<0.05) increase in insulin secretion was observed on HF. Further study detected somatostatin substance, a kind of antagonist for insulin secretion, in the HF filtrate. HF was somewhat better than HD in lowering the triglyceride level.
This study suggests that HF is probably more effective than HD in regard to glucose and lipid metabolism of diabetic patients on dialysis.
