Hemodialysis in patients with diabetes mellitus

  • Anne Marie Miles


Miles focuses on currently possible improvements in the hemodialysis regimen as a means of reducing morbidity and mortality. Noting that diabetic hemodialysis patients have a 20% greater rate of intradialytic hypotension, and that recurrent intradialytic hypotension results in underdialysis, this complication is analyzed in detail. Potential management strategies are proposed including a lower ultrafiltration rate with increased duration of hemodialysis treatments. Proposed corrective measures such as limiting meals before or during hemodialysis, omitting antihypertensive medications on the morning of hemodialysis, and leg toning exercises to improve venous return are refreshing in their simplicity and avoidance of expense. An apparently higher rate of vascular access thrombosis is attributed to a greater use of synthetic grafts in diabetic hemodialysis patients. But, resort to a synthetic graft over a primary arterio-venous fistula is often a decision forced by inadequate or damaged vessels at the time of access creation. No easy remedy for effective vascular access in diabetic hemodialysis patients is evident.


Vascular Access Synthetic Graft Intradialytic Hypotension Interdialytic Weight Gain 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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    US Renal Data System, USRDS 1997 Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, April 1997.Google Scholar
  2. 2.
    Comty CM, Leonard A, Shapiro FL. Management and prognosis of diabetic patients treated by chronic hemodialysis. Am Soc Nephrol 1971; 5: 15–19.Google Scholar
  3. 3.
    Ghavamian M, Gutch CF, Kopp KF et al. The sad truth about hemodialysis in diabetic nephropathy. JAMA 1972; 222: 1386–1389.PubMedCrossRefGoogle Scholar
  4. 4.
    Comty CM, Kjellsen D, Shapiro FL. A reassessment of the prognosis of diabetic patients treated by chronic hemodialysis. Trans Am Soc Artif Intern Organs 1976; 22: 404.PubMedGoogle Scholar
  5. 5.
    Miles AMV, Friedman EA. Managing comorbid disorders in the uremic diabetic patient. Sem Dial 1997; 10: 225–230.CrossRefGoogle Scholar
  6. 6.
    Shideman JR, Buselmeier TJ, Kjellstrand CM. Hemodialysis in diabetics. Arch Intern Med 1976; 136: 1126–1130.PubMedCrossRefGoogle Scholar
  7. 7.
    Collins AL, Liao A, Umen A, Hanson G, Keshaviah P. Diabetic hemodialysis patients treated with a high Kt/V have a lower risk of death than standard Kt/V. J Am Soc Nephrol 1991; 2: 318.Google Scholar
  8. 8.
    Nakamoto M. The mechanism of intradialytic hypotension in diabetic patients. Nippon Jinzo Gakkai Shi. Jap J Nephrol 1994; 36: 374–381.Google Scholar
  9. 9.
    Ritz E, Strumpf C, Katz F et al. Hypertension and cardiovascular risk factors in hemodialyzed diabetic patients. Hypertension 1985; 7(Suppl II): 118–124.Google Scholar
  10. 10.
    Daugirdas JT. Dialysis hypotension: A hemodynamic analysis. Kidney Int 1991; 39: 223–246.CrossRefGoogle Scholar
  11. 11.
    Gotch FA, Keen ML, Yarian SR. An analysis of thermal regulation in hemodialysis with one and three compartment models. Trans Am Soc Artif Intern Organs 1989; 35: 622–624.CrossRefGoogle Scholar
  12. 12.
    Ifudu O, Dulin A, Lundin AP et al. Diabetics manifest excess weight gain on maintenance hemodialysis. Am Soc Artif Intern Org 1992; 21: 85.Google Scholar
  13. 13.
    Jones R, Poston R, Hinestrota A et al. Weight gain between dialysis in diabetics. Possible significance of raised intracellular sodium content. Br Med J 1980; 1: 153–154.CrossRefGoogle Scholar
  14. 14.
    Taber TE, Maikranz PS, Haag BW et al. Maintenance of adequate hemodialysis access. Prevention of neointimal hyperplasia. ASAIO J 1995; 41: 842–846.PubMedGoogle Scholar
  15. 15.
    Gensini GF, Abbate R, Favilla S, Neri Serneri GC. Changes of platelet function and blood clotting in diabetes mellitus. Thromb Hemost 1979; 42: 983–993.Google Scholar
  16. 16.
    Halushka PV. Increased platelet thromboxane. J Lab Clin Med 1981; 97: 87–92.PubMedGoogle Scholar
  17. 17.
    US Renal Data System, USRDS 1997 Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 1991.Google Scholar
  18. 18.
    US Renal Data System, USRDS 1993 Annual Data Report. National institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD, Aug 1993.Google Scholar
  19. 19.
    Mayers JD, Markell MS, Cohen LS et al. Vascular access surgery for maintenance hemodialysis. Variables in hospital stay. Am Soc Artif Int Org J 1992; 38: 113–115.Google Scholar
  20. 20.
    Woods JD, Turenne MN, Strawderman RL et al. Vascular access survival among incident hemodialysis patients in the United States. Am J kid Dis 1997; 30: 50–57.PubMedCrossRefGoogle Scholar
  21. 21.
    Tzamaloukas AH, Murata GH, Harford AM et al. Hand gangrene in diabetic patients on chronic dialysis. Trans Am Soc Artif Intern Organs 1991; 37: 638–643.Google Scholar
  22. 22.
    Redfern AB, Zimmerman NB. Neurologic and ischemic complications of upper extremity vascular access for dialysis. J Hand Surg — American Volume. 1995; 20: 199–204.CrossRefGoogle Scholar
  23. 23.
    Wilbourn AJ, Furlan AJ, Hulley W, Ruschhaupt W. Ischemic monomelic neuropathy. Neurology 1983; 33: 447–451.PubMedCrossRefGoogle Scholar
  24. 24.
    Riggs JE, Moss AH, Labosky DA, Liput JH et al. Upper extremity ischemic monomelic neuropathy: a complication of vascular access procedures in uremic diabetic patients. Neurology 1989;39: 997–998.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • Anne Marie Miles

There are no affiliations available

Personalised recommendations