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Dialysis in diabetic patients: three decades of experience, from 1964 to 1997

  • M. M. Avram
Chapter

Abstract

When Avram first reported in 1966 that diabetic uremic patients might benefit from repetitive hemodialyses, no one was prepared for the extent of diabetic nephropathy that was unmasked. Over the ensuing three decades, every estimate of how many ESRD patients would have diabetes has been surpassed. The upward slope of both the incidence and prevalence curves for diabetic ESRD patients has not yet leveled off. Searching for markers of morbidity and mortality in the expanding number of diabetic ESRD patients, Avram’s group added protein-energy malnutrition to recognized risk factors including hypertension and poor metabolic control. A comprehensive management strategy for diabetic kidney patients is proposed employing early treatment with erythropoietin, cardiovascular protection by diet, exercise and/or drugs, maintaining normal body weight, and blood pressure control. Remembering the early trials of dialytic therapy in diabetes when first-year survival was less than 25%, current prospects for a 75% survival in newly started hemodialysis patients indicates remarkable progress. Still, rehabilitation presently is far from satisfactory and further modifications in diabetic management to reduce comorbidity — including assessing the value of aminoguanidine to block micro and macrovascular complications are under active clinical trial.

Keywords

ESRD Patient Peritoneal Dialysis Patient Renal Data System Nutritional Marker Annual Data Report 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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© Springer Science+Business Media Dordrecht 1998

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  • M. M. Avram

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