Dialysis in patients with diabetic nephropathy; A comparison between hemodialysis and CAPD
Summary: Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are two established modalities of renal replacement therapy in diabetes mellitus (DM). Controlled trials for comparison of CAPD versus HD treatment of diabetics show conflicting results. The aim of our study was to assess the effects of HD and CAPD in diabetic end stage renal disease patients. We compared the characteristics of 37 diabetic patients on HD (Group 1; 17 female, 20 male, 10 IDDM, 27 NIDDM, mean age 53 ± 13 years, predialysis DM duration of 15.5 ± 5.8 years, HD duration of 35 ± 27 months) to 16 diabetic patients on CAPD (Group II; 4 female, 12 male, 4 IDDM, 12 NIDDM, mean age 53 ± 16 years, predialysis DM duration of 15.6 ± 3.8 years, CAPD duration of 14.5 ± 11 months). Clinical characteristics (control of hypertension and hypotension, erythropoietin requirement per week), laboratory parameters (hemoglobin, BUN, creatinine, K, Ca, P, CRP, ferritin, total cholesterol, LDL, HDL, triglyceride, albumin, prealbumin, parathormone, fibrinogen, echocardiographic findings, blood glucose and HbA1c level) of all patients were evaluated. Student t-test and chi-square test were used as statistical analysis. According to our results, in CAPD group, incidence of optimum blood pressure levels (p=0.0001), Hb (p=0.017), LDL (p=0.002) and fibrinogen levels (p=0.019), were significantly higher than HD group in CAPD patients. We conclude that in diabetic patients CAPD has beneficial effects on easier control of hypertension, anemia, blood glucose level, slow sustained ultrafiltration, avoidance of cardiac complications and hypotension. On the other hand, lipid profile disorders as high LDL levels, hyperfibrinogenemia, hypoalbuminemia seemed to appear as disadvantages of CAPD.
Comment: Currently there are wide variations in the management of dialysis patients world-wide. Although, at present regular HD and CAPD are two well established renal replacement therapies, the proportion of dialysis patients treated by either of the two modalities varies greatly between countries. However, although patients have a similar quality of life and outcome with both modalities, contrary to HD, CAPD is not dependent on highly trained personal and expensive equipment, it is less costly and herefore, may be performed at home and in rural areas by relatives of the uremic patients after a few training sessions, these factors make CAPD an ideal mode of renal replacement therapy in developing countries. Yet, in most developing countries, HD is the main type of renal replacement therapy for a variety of reasons. For example in Iran, despite the production of CAPD dialysis solution internally a negligible proportion of patients are on CAPD and this number is rapidly decreasing., while the number of patients treated by HD is progressively increasing. It would therefore be prudent to examine the reasons behind the unpopularity of CAPD therapy and to implement appropriate measures to encourage CAPD in the developing countries.
Parviz Khajehdehi MD, Shiraz University of Medical Sciences, Shiraz, Iran
Source: Sengul S, Ozdemir FN, Arat Z, Colak T, Istman M, Turan M, Haberal M, Nephrol Dial Transplant 2000, 15: A99.