Hemodialysis in patients with diabetes mellitus
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.
KeywordsVascular Access Synthetic Graft Intradialytic Hypotension Interdialytic Weight Gain Annual Data Report
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