Abstract
We investigated the relationship between exacerbation of diabetic gangrene and dialysis treatment in diabetic patients undergoing CAPD (n=20) and hemodialysis (n=10). While six patients on CAPD suffered diabetic gangrene, and all of them died within two years, none of the hemodialysis patients has developed diabetic gangrene.
To investigate factors responsible for the development and exacerbation of diabetic gangrene, we divided the patients into three groups, a CAPD-gangrene group (group A, n=6), a CAPD-non-gangrene group (group B, n=14), and a hemodialysis group (group C, n=10). There were no differences among the three groups with respect to age, duration of diabetes, smoking, retinopathy, neuropathy, calcification of the aorta, Ca or P metabolism, or lipid profiles. In the case of glucose metabolism, however, the fasting glucose concentrations were 270.0±71.4, 169.5±44.1 and 138.8±42.2mg/dl, and the HgA1c levels were 10.8±1.0, 7.5±1.4 and 6.5±0.6% in groups A, B and C, respectively, and blood glucose control was significantly worse in group A than in group B (p<0.01) and group C (p<0.0001), in spite of using high doses of insulin in group A. Average blood pressures were 144±13/79±14, 154±13/83±10 and 163±13/84±5mmHg, respectively, and significantly lower in group A than in group C (p<0.01), although a few patients were taking antihypertensive drugs. Serum albumin concentrations were 2.5±0.3, 3.1±0.4 and 4.0±0.6g/dl, respectively, and the serum albumin level was lowest in group A. In addition, patients in group A experienced many episodes of vomiting and were often admitted for dehydration.
In conclusion, the risk of diabetic gangrene was multifactorial, with the following being considered risk factors: poor blood glucose control, hypoproteinemia, hypotension, dehydration. We need to routinely examine high-risk CAPD-diabetic patients very carefully to detect the initial evidence of gangrene.
