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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Progression of diabetic nephropathy from the stage of macroproteinuria with near-normal renal function until start of dialysis was compared in 16 patients with type I and 16 patients with type II diabetes mellitus. The mean creatinine clearance at the beginning of the study was 89 +/- 13 ml/min/1.73 m2 in patients with type I and 81 +/- 6 ml/min/1.73 m2 in those with type II diabetes. Dialysis was started after a mean interval of 77 (44-133) months, when creatinine clearance had decreased to 8 +/- 2 ml/min/1.73 m2 in type I diabetic patients. The respective figures for type II diabetic patients were 81 (40-124) months and 7 +/- 2 ml/min/1.73 m2. The mean rate of decrease in creatinine clearance was 1.05 +/- 0.45 ml/min/month in type I and 0.91 +/- 0.41 ml/min/month in type II diabetes. The mean rate of decrease was 1.46 +/- 0.30 ml/min/month in type I diabetic patients with a systolic BP > 160 mmHg versus 0.80 +/- 0.42 ml/min/month with < 160 mmHg (P < 0.01). In the type II diabetics the respective figures were 1.38 +/- 0.40 ml/min/month versus 0.78 +/- 0.15 ml/min/month (P < 0.01). During the observation period the prevalence of coronary heart disease increased from 6 to 50% in type I and from 31 to 87% in type II diabetes. In conclusion, the rate of progression of diabetic nephropathy during the predialytic phase is similar in type I and type II diabetes; BP adversely affects the rate of progression to the same extent in both groups.
Nephrol Dial Transplant 1994
PMID:Similar rate of progression in the predialysis phase in type I and type II diabetes mellitus. 780 Feb 7

Patients with chronic renal failure show an excess mortality from cardiovascular disease (CVD). Over a 4-year period (1983-1986) we have prospectively studied 305 patients (177 men, 128 women) from a geographically constrained population entering a renal replacement therapy (RRT) programme. The development of new cardiovascular events and patient survival have been documented up to the end of 1990. We have determined the incidence of CVD amongst the patients compared to the general population of the region and assessed the predictive value for future cardiovascular events of risk factors present at the start of RRT. One hundred and fourteen patients experienced a new cardiovascular event. One hundred and fifteen patients died, 89 from CVD. Stratification by age and sex identified diabetes, previous coronary heart disease, and cardiomegaly to be significantly associated with an increased risk of a cardiovascular event, and diabetes, previous coronary heart disease, and accelerated hypertension to be significantly associated with an increased risk of cardiovascular death. Mortality from CVD was 10.1 times that of the corresponding general population, and was increased 44 times for patients with diabetes. Duration of RRT did not influence mortality rates. This excessive early mortality has significant implications for RRT programmes and further research is necessary to identify individuals at risk and the modifiable risk factors that could receive targeted interventional therapy.
Nephrol Dial Transplant 1994
PMID:Comparative mortality from cardiovascular disease in patients with chronic renal failure. 780 Feb 14

In a retrospective analysis of 202 renal transplant procedures in the years 1989-1992 we identified an excess of grafts lost from primary renovascular thrombosis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) compared to haemodialysis (HD) patients (9 CAPD versus 0 HD, Chi-squared = 9.63; P < 0.01). All graft losses from thrombosis occurred within 16 days of surgery. Possible predisposing causes were identified in three patients. Donor age was greater in CAPD patients losing their kidneys from thrombosis compared to the overall CAPD group [mean (SD) years, 43.0(12.9) versus 29.1(15.8); P = 0.01] whereas no significant difference in haematocrit, platelet count, antibody status, cyclosporin use, peroperative hypotension, primary diagnosis, smoking, or diabetes mellitus was found. Data from the EDTA registry for 1990-91 show that graft loss from primary renovascular thrombosis in UK-treated patients was reported in 7.1% of CAPD recipients compared with 1.8% in haemodialysis. We suggest that CAPD patients are at greater risk of graft loss from renovascular thrombosis than HD patients and may require more intensive fluid and anticoagulant treatment in the perioperative period.
Nephrol Dial Transplant 1994
PMID:Increased renal allograft thrombosis in CAPD patients. 891 57

Age-specific and cumulative incidence rates were calculated for entry into Australian end-stage renal failure programmes from 1972 to 1991, as a result of all causes, or from analgesic nephropathy, glomerulonephritis, hypertension and vascular disease, or diabetes. Three different trends were demonstrated. A rising recorded incidence of renal failure occurred throughout the period of observation in those aged 0-4 years (all causes) and in those aged 55 years and over (all categories, least in analgesic nephropathy) principally attributable to a falling fraction of patients not accepted for treatment. Falling incidence rates indicating a real reduction in the burden of disease were seen for analgesic nephropathy (at least up to the age of 64 years) and hypertension and vascular disease (only up to the age of 54 years). In young adults the unchanging incidence of renal failure due to all causes, glomerulonephritis and diabetes probably reflect nearly complete acceptance rates into end-stage renal failure programmes, and therefore approximate the true burden of disease. In end-stage renal failure, age-specific or age-standardized cumulative rates are required to distinguish rising or falling incidence of disease from trends due to changing medical practice.
Nephrol Dial Transplant 1994
PMID:Trends in incidence of end-stage renal failure in Australia, 1972-1991. 781 48

We have compared the kidneys of two inbred strains of rats (Lewis and Lewis-Dwarf) 7 days after the induction of diabetes mellitus with streptozotocin, in order to examine the influence of a selective growth hormone (GH) deficiency on diabetic renal growth and insulin-like growth factor-I (IGF-I) content of the kidneys. Insulin-like growth factor-I (IGF-I) content of the kidneys. Insulin-like growth factor-I was measured by radioimmunoassay and its distribution within the kidney by immunohistochemical staining. We detected a significant increase in both the wet weight (32.9 +/- 5.3%, P = 0.0085) and dry weight (16.3 +/- 6.3%, P = 0.046) of the kidneys of diabetic Lewis rats but dwarf rats, selectively deficient in GH, did not show a significant increase in either parameter. Extractable IGF-I increased within the kidneys of diabetic rats of both strains but to a lesser extent in the dwarf rats (+105 +/- 28% and +65 +/- 21% respectively, P < 0.01). In diabetic Lewis rats a positive correlation was noted between the severity of glycaemia and kidney IGF-I content (r = 0.604, P < 0.05) but no such correlation was noted in dwarf rats. Inulin-like growth factor-I immunostaining increased in diabetic rats of both strains, mainly within cells of the thick ascending limb of the loop of Henle including damaged and vacuolated cells. However, morphometric analysis of the staining showed that it was significantly less widespread in the diabetic dwarf rats (P = 0.026).(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrol Dial Transplant 1994
PMID:Experimental diabetic renal growth: role of growth hormone and insulin-like growth factor-I. 781 51

A portion of peritonitis episodes are reported as culture-negative or as initial no growth peritonitis (INGP). To determine if demographics, symptoms, signs, treatment, and outcome were different in INGP when compared to culture-positive peritonitis (Pos), we examined data from the Network 9 Peritonitis and Catheter Survival Study. Only peritonitis episodes occurring in adults with peritoneal dialysis (PD) fluid WBC counts greater than 100 were included in the analysis. INGP accounted for 14% of the episodes of peritonitis. Organisms grew out of 13 of the 37 patients in INGP that were recultured: 3 fungal, 5 gram-negative, and 5 gram-positive isolates. A difference in culture methodology for the two groups could not be detected. There was no difference in gender, race, incidence of diabetes, previous peritonitis, or exit-site infections between the two groups. INGP had a greater percentage of patients over age 70 (23.3% vs 14.7%, p < 0.05), and a larger percentage of INGP patients placed additives in their dialysate (55% vs 43.6%, p < 0.05). There was no difference in symptoms or signs between the two groups. The INGP group had half the catheter removal rate (9/103 vs 110/630 for Pos, p < 0.05), otherwise, there was no difference in the rate of hospitalization, death, or switch to hemodialysis. There was no difference in types of drugs used or method of drug administration between the two groups. A lower percentage of INGP patients were treated for 6 days or less and a higher percentage received 7-10 days of intraperitoneal (IP) therapy when compared to Pos.(ABSTRACT TRUNCATED AT 250 WORDS)
Adv Perit Dial 1994
PMID:Culture-negative CAPD peritonitis: the Network 9 Study. 799 21

The peritoneal equilibration test (PET) is used as a tool for dialysis prescription. In order to establish which parameters can predict peritoneal transport type, we studied 55 patients on continuous ambulatory peritoneal dialysis (CAPD), who were subjected to a standard PET. Clinical data (sex, age, calculated body surface area [BS], average time on dialysis [TD], and presence of diabetes mellitus), laboratory variables, (serum creatinine [SCr] blood urea nitrogen [BUN], serum albumin [SA], and residual renal function), and adequacy parameters (dialysate creatinine clearance [CrCl], weekly clearance of urea normalized to total body water [KT/V], protein catabolic rate, and dialysis index), were obtained and recorded at the time of the PET. The study group was composed of 29 males and 26 females, mean age of 43.5 +/- 16 years, and average TD of 25.2 +/- 18 months. PET results: 13 patients were low, 16 low average, 19 high average, and 7 high peritoneal transporters. According to the logistic regression analysis, the factors significantly associated with the type of peritoneal transport were: BS, SA, dialysate CrCl, and TD (coefficients 7.2, -1.23, 0.72, and -0.03, respectively). Greater BS and lower SA directly correlate with high peritoneal transport, and are the strongest predictors for the model.
Adv Perit Dial 1994
PMID:Serum albumin and body surface area are the strongest predictors of the peritoneal transport type. 799 63

There has been a gradual increase in the number of diabetic and elderly patients maintained on continuous ambulatory peritoneal dialysis (CAPD) replacement therapy. Eighty randomly selected patients were studied over two years. Weekly normalized urea clearance (KT/Vurea), weekly creatinine clearance/1.73 m2 body surface area (BSA) (Ccr), and protein catabolic rate (PCR) were measured. Selected clinical outcome criteria were assessed. Weekly KT/Vurea was correlated with weekly Ccr (r = 0.538, p < 0.001), and weekly KT/Vurea was correlated with PCR (r = 0.393, p < 0.001). Patients were then stratified according to presence or absence of diabetes mellitus and age > 60 or < or = 60 years. Diabetic and nondiabetic patients had similar weekly KT/Vurea, weekly Ccr, PCR, serum albumin levels, weekly erythropoietin (EPO) requirements, peritonitis rates, and CAPD-related hospitalization rates. The total hospitalization rates, however, were higher in diabetic patients. Elderly and younger patients had similar weekly KT/Vurea, weekly Ccr, PCR, serum albumin levels, and weekly EPO requirements. Elderly patients, however, had higher peritonitis rates and higher total and CAPD-related hospitalization rates.
Adv Perit Dial 1994
PMID:Selected outcome criteria and adequacy of dialysis in diabetic and elderly patients on CAPD therapy. 799 72

The present work studies the urinary excretion of PGE2 and PGI2 (6-keto PGF 1 alpha) in 11 insulin-dependent diabetic patients with chronic renal failure with a glomerular filtration rate of 33.9 +/- 9.03 ml/min who had hyporeninaemic hypoaldosteronism to evaluate the influence of these prostaglandins on the appearance of this latter process. The results obtained in this group of patients were compared with those of a control group of healthy individuals, another group of nine non-diabetic patients with CRF, and a last group of eight insulin-dependent diabetic patients with normal renal function to evaluate to what extent the possible variations in prostaglandin excretion could be related to the diabetes, CRF, or a conjunction of both processes. The results of the groups of diabetic patients with CRF were Ccr 33.9 +/- 9.03 ml/min, decreased (P < 0.0001) with respect to the control group and with no difference with the CRF group without diabetes; plasma potassium (4.7 +/- 0.4 mEq/l), increased (P < 0.005) with respect to the values found in the control group; plasma bicarbonate (17.8 +/- 1.8 mEq/l), decreased (P < 0.005) with respect to the control group and also, though not significantly, with respect to the group of non-diabetic patients with CRF. Plasma aldosterone (pg/ml): resting 44.3 +/- 14.9; standing 65.7 +/- 63.5 and post-frusemide 65.5 +/- 58.6, decreased (P < 0.01) with respect to the other three groups. Plasma renin activity (PRA) (ng/ml/h): resting 0.34 +/- 0.3; standing 0.6 +/- 0.4, post-frusemide 0.9 +/- 0.5, decreased significantly with respect to the other three groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrol Dial Transplant 1994
PMID:Urinary prostaglandins (PGE2 and PGI2) in hyporeninaemic hypoaldosteronism in diabetic patients with chronic renal failure. 805 30

Radionuclide gastric emptying studies were carried out on 20 patients with end-stage renal failure (ESRF) undergoing continuous ambulatory peritoneal dialysis (CAPD). Nine of the patients had diabetes mellitus. Eight normal volunteers were also studied to establish normal ranges. Solid and liquid emptying patterns were investigated simultaneously using a meal made up of a solid phase labelled with 99mTechnetium and a liquid phase labelled with 111Indium. The solid emptying fitted a model with a lag phase followed by a linear emptying phase and the liquid emptying fitted a single exponential. Nine of the 20 patients (four diabetic, five non-diabetic) were found to have delayed solid emptying, and four of these (two diabetic, two non-diabetic) also had delayed liquid emptying. No correlation was found between any of the parameters studied and the clinical symptoms of the patients. It is concluded that almost half of the patients studied had abnormal gastric emptying, but that many of these did not suffer from severe symptoms.
Nephrol Dial Transplant 1994
PMID:Gastric emptying in patients with chronic renal failure on continuous ambulatory peritoneal dialysis. 772 72


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