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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

End-stage renal disease (ESRD) is defined as renal insufficiency requiring dialysis or kidney transplantation for survival. In the United States, diabetes mellitus is the major cause of ESRD. This report summarizes trends during the 1980s in the incidence of treatment for ESRD attributable to diabetes mellitus (ESRD-DM).
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PMID:Incidence of treatment for end-stage renal disease attributed to diabetes mellitus--United States, 1980-1989. 143 69

A 66-year-old white man presented with severe chronic renal failure. He had no past or present symptomatic glucose intolerance nor a family history of diabetes mellitus. Several fasting plasma glucose determinations, hemoglobin Alc and an oral glucose tolerance test were normal. Funduscopic ophthalmoscopy and retinal fluorescein angiography did not demonstrate diabetic retinopathy. The kidney biopsy showed nodular diabetic nephropathy, with increased mesangial matrix, thickened glomerular basement membrane, and afferent and efferent glomerular arteriolar hyalinization. The diagnosis of nodular diabetic nephropathy was made in this patient in the absence of past or present or familial evidence of diabetes mellitus.
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PMID:Nodular diabetic glomerulosclerosis without diabetes mellitus. 143 40

The percent distribution of selected comorbid conditions from a national sample of 3,399 Medicare patients starting maintenance hemodialysis in 1986-87 is described. Using the Cox proportional hazards model, the relative mortality risk (RR) was assessed for comorbid conditions at time of ESRD while adjusting for the other comorbid and demographic covariates. Coronary artery disease and congestive heart failure, each present in 41 percent of patients, were associated with RR of 1.22 and 1.26 respectively (p < 0.0005 each). Fifty percent of patients had a serum albumin concentration at onset of ESRD of less than 3.5 gm/dl, and an increased risk of dying. Additionally, patients recorded as undernourished had an elevated risk (RR = 1.34, without adjustment for serum albumin, p < 0.0001). Other factors associated with a statistically significant increased mortality risk (p < 0.005) included older age, diabetes as cause of ESRD (particularly if insulin dependent), history of neoplasm, active smoker, and relatively low serum creatinine concentration. By describing the magnitude of risk associated with comorbid conditions, this study emphasizes the need for preventive efforts during the pre-ESRD stages of renal impairment. Studies are needed to document whether improvement in serum albumin or other comorbid factors before ESRD leads to reduction in mortality risk for ESRD patients.
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PMID:Comorbid conditions and correlations with mortality risk among 3,399 incident hemodialysis patients. 144 73

The long-term effects of hemodialysis in diabetic patients with end stage renal disease (ESRD) may seem minor, yet with further examination are seen to touch every aspect of the patients' lives. The long-term effects range from vascular access issues, complications such as limb amputation, to feelings of loss of control as well as hopelessness and powerlessness. This article will highlight how the long-term outcomes and effects of hemodialysis with diabetes cause multisystem problems and multiple complications in patients.
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PMID:Long-term effects of hemodialysis in diabetic patients with end stage renal disease. 145 91

Combined kidney-pancreas transplantation is a safe and effective treatment option for patients with end stage renal disease (ESRD) resulting from type I diabetes. Current 1 year graft survival rates are nearing 80% and evidence is accumulating that improvement occurs in microvascular and neuropathic complications of diabetes after transplantation. This article is a detailed overview based on the current literature and our experience at The University Hospitals of Cleveland of the challenges and benefits of kidney-pancreas transplantation and the nursing care required to prepare the patient for home.
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PMID:Kidney-pancreas transplantation: a treatment option for ESRD and type I diabetes. 145 93

This study was designed to compare changes in lipid status following organ transplantation between type I diabetes mellitus (DM-I) patients receiving combined pancreas-kidney transplantation (PKT) with those receiving kidney transplantation alone (KTA). A retrospective chart review was used to identify pre- and posttransplantation fasting total cholesterol (TC) and triglycerides (TG) in three groups: DM-I patients receiving KTA (DM:KTA; n = 14), DM-I patients receiving PKT (DM:PKT; n = 20), and kidney transplant recipients without DM (NDM; n = 16). The groups were matched for age, gender, weight, duration of dialysis, smoking history, and duration of diabetes mellitus. Linear regression was used to analyze differences in lipid trends over time (up to 24 months posttransplantation) and the effects of prednisone dose, cyclosporine dose, and serum creatinine. Preoperative TC was significantly lower in the DM:KTA group (P < 0.05) compared with DM:PKT or NDM. There were no significant differences in preoperative TG between the three groups. TC and TG decreased over time only in DM:PKT (P = 0.0112, P = 0.0278, respectively). TC increased and TG was unchanged over time in DM:KTA (P = 0.0003, P = 0.1103, respectively). Neither TC nor TG changed over time in NDM. Trends of TC and TG for DM:PKT were significantly different from DM:KTA (P < 0.01 for both). Trend of TC for NDM was also significantly different from DM:PKT (P = 0.0061). Prednisone dose was significantly related to TC in DM:KTA and NDM (P < 0.01) while cyclosporine dose was significantly related to TC for DM:KTA only (P = 0.0013) in the presence of time. None of the variables tested (prednisone dose, cyclosporine dose, and serum creatinine) significantly affected TG in the presence of time. In summary, TC and TG decreased over time only in DM:PKT. In contrast, TC increased while TG was unchanged in DM:KTA over the same interval (0-24 months). If these trends continue, the beneficial change in lipids in the DM:PKT group may translate into a net improvement in atherosclerosis-mediated events for diabetic patients with chronic renal failure who receive PKT compared with those who do not.
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PMID:Lipid status after combined pancreas-kidney transplantation and kidney transplantation alone in type I diabetes mellitus. 146 93

Seventy-nine patients of end stage renal disease (ESRD) on maintenance haemodialysis were studied. Most of the cases were in their prime of life. The disease was equally common in both sexes and all ethnic groups. Chronic glomerulonephritis was the commonest cause followed by diabetes mellitus. Hypertension was the commonest associated illness. All patients were screened for hepatitis B surface antigen and antibody and those found negative were vaccinated. A-V fistula in the upper extremity was used as the vascular access in 93% cases. In 68% cases dialyzer was reused without any ill effect. Amongst the complications observed, hypotension was seen in 65%, psychological disorders in 52%, followed by nausea, vomiting, itching and cramps. Technical complications were related to A-V fistula in 45% cases. Forty three percent patients were maintained without blood transfusion and 88% showed improvement in their quality of life.
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PMID:Experience of haemodialysis at the Kidney Centre. 146 63

We performed 7 cases of pancreas transplantation (PTX), simultaneous pancreas and kidney transplantation in 4 cases, and PTX after kidney transplantation in 3 cases. The pancreas and kidney were extirpated after in situ perfusion using UW solution and stored in UW solution. The pancreas was transplanted in the left iliac fossa with bladder drainage, and the kidney was placed in the contralateral iliac fossa. The immunosuppressive regimen consisted of cyclosporine, methylprednisolone, azathioprine and antilymphocyte globulin. Gabexate mesilate (30-40 mg/kg/day) and PGE1 (5 ng/kg/min) was administered intravenously to prevent the vascular thrombosis. The original diseases of 7 patients were insulin-dependent diabetes mellitus (IDDM) with chronic renal failure, retinopathy and neuropathy. Six out of 7 patients became insulin-free after PTX, while one patient developed the vascular thrombosis in the pancreatic graft which was removed after 12 hours after the transplantation. All patients became dialysis-free and serum creatinine was ranging from 1.5 to 2.0 mg/dl. HbAlc remained within normal range in 6 out of 7 patients, who showed normal to borderline glucose tolerance in 75g oral glucose tolerance test. Although further investigation will be required, PTX from cardiac-arrest donor will be promising as one of the therapeutic modalities for IDDM patients.
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PMID:[Combined pancreas and kidney transplantation for IDDM patients with diabetic renal failure]. 147 Jan 68

To evaluate the mortality of continuous ambulatory peritoneal dialysis (CAPD) patients relative to hemodialysis (HD) patients, all Michigan residents 20 to 59 yr of age who initiated therapy for ESRD during the 1980s (N = 4,288) were studied. The study population was stratified by primary renal diagnosis (glomerulonephritis, hypertension, diabetes, other), and analyses were conducted within each group by Cox proportional hazards methods controlling for age, race, sex, and year in which chronic dialysis was initiated. Intent-to-treat (ITT) and treatment history (RxHx) censoring criteria were used. For patients with hypertension or other reported causes of ESRD, there was no significant difference in CAPD and HD patient mortality (relative risk (RR) = 0.99 and 1.05, respectively). In the ITT analysis, both glomerulonephritic (RR = 0.73; P = 0.10) and diabetic patients using CAPD experienced mortality rates lower than their HD counterparts. Among diabetics, this difference ranged from a RR of 0.40 to 0.70, being lowest for younger diabetics and statistically significant (P < or = 0.05) for ages 20 to 52 yr. Evaluation of mortality trends showed a significant (P < 0.01) decrease in diabetic CAPD mortality rates during the decade, whereas diabetic HD mortality rates increased (P = 0.06). Among diabetics, men had higher mortality rates than women (ITT--RxHx; RR = 1.22 to 1.27; P < 0.001) and white patients had higher mortality rates than black patients (ITT--RxHx, RR = 1.34 to 1.44; P < 0.001). Differences in mortality by sex and race were not found among nondiabetics, but mortality did increase significantly with age in all groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of continuous ambulatory peritoneal dialysis and hemodialysis patient survival with evaluation of trends during the 1980s. 148 53

Subjects with chronic renal failure have a greatly increased risk of coronary heart disease and dyslipidemia. Relatively few studies have examined the relationship of chronic renal failure to lipoprotein (Lp)(a) concentrations, an important risk factor for coronary heart disease. Diabetic subjects have been reported to have both increased Lp(a) concentrations and an increased risk of renal failure, thereby possibly confounding the Lp(a)-renal failure association. The association between Lp(a) and chronic renal failure in 359 control subjects and 111 subjects with renal failure was examined. Lp(a) (in milligrams per deciliter) was elevated in subjects with chronic renal failure, regardless of ethnicity (Mexican Americans, 19.8 +/- 2.7 versus 14.1 +/- 1.3; P = 0.03; non-Hispanic white patients, 24.9 +/- 3.0 versus 16.3 +/- 1.2; P = 0.006;). These differences persisted after adjustment for diabetes and ethnicity (P < 0.001). The type of treatment for chronic renal failure (diet, hemodialysis, or peritoneal dialysis) did not have an effect on Lp(a) concentrations. Lp(a) levels were not correlated with the level of creatinine in subjects with chronic renal failure. Thus, the elevation of Lp(a) levels in renal failure must occur early in renal failure, or alternatively, elevated Lp(a) levels may promote progression to chronic renal failure. These results indicate that Lp(a) concentrations are increased in chronic renal failure and may increase the risk for coronary heart disease in these subjects.
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PMID:Increased lipoprotein(a) concentrations in chronic renal failure. 148 54


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