Volume 3, Issue 2 p80-4 (1982)
The respective merits of hemodialysis (HD) and transplantation (TP) in the treatment of 25 patients with diabetic renal failure are analyzed. Overall patient survival whatever the method of treatment is 72% at one year and 50% at 4 years. One year survival is 67% for patients treated only by HD and 81% after TP. This difference results in part from the fact that early death after the initiation of therapy occurs usually during HD prior to TP. Death results mainly from cardiovascular disease (6/7 deaths) in HD and from infectious complications (5/9 deaths) after TP. Taken together with death, rejection of 11/19 grafts reduces graft survival to 56% at one year and 33% at 2 years. Progression of cardiovascular, ocular and neurologic complications is similar whatever the mode of treatment. Recurrence of diabetic renal disease was documented in the graft of one patient. All patients with a 2 year survival (6 grafted, 1 dialyzed) have an excellent rehabilitation. Altogether both methods of treatment appear satisfactory. The initial pessimism regarding the outcome of HD treatment appears unwarranted. Unfortunately, both HD and TP remain marred by a greater number of complications in diabetic than in non-diabetic patients. Initiation of therapy at an earlier stage of the disease and better control of the diabetes might further improve results.
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