Pietrzak B, Olszowska A, Wańkowicz Z
Kliniki Nefrologii ze Stacja Dializ, Centralnego Szpitala Klinicznego Wojskowej Akademii Medycznej, Warszawie.
Pol Merkur Lekarski. 1998 Nov;5(29):271-3.
Controversy around the place of CAPD in renal replacement therapy of blind Diabetics (BD) with type 1 Diabetes induced us to start CADP programme also in this group of patients. In yrs 95-98 we treated with CAPD 5 BD send to our Centre in IV/V phase of diabetic nephropathy (acc. to Mogensen). Duration of D up to 20 yrs, complete blindness in the last 2-10 yrs. Criteria of qualification for CAPD: standard medical +motivation of patient and family helper for self dialysis, unaided everyday life as well as blindness not before maturity. CAPD equipment: twin bag system with special modifications for BD. Own training programme of 2 weeks for patient/family helper modified for BD (without visual aids). We achieved full clinical and biochemical compensation of uremia; KT/Vurea > 1.9, weekly creatinine clearance > 60 1/1.73 sqm, UF > 400 ml. Peritonitis occurred in 2 of 5 patients with ratio 1:28 ptsmnths.
for BD with type 1 Diabetes, leading unaided everyday life, the blindness doesn't seem to be limitation for CAPD, if patients are motivated for self dialysis and the training programme has been specially modified for them.
1型糖尿病致盲糖尿病患者(BD)在肾脏替代治疗中应用持续性非卧床腹膜透析(CAPD)存在争议,这促使我们也在这类患者中启动CAPD项目。在1995 - 1998年期间,我们对5例处于糖尿病肾病IV/V期(根据莫根森分期)并被送至我们中心的BD患者进行了CAPD治疗。糖尿病病程长达20年,在过去2 - 10年完全失明。CAPD治疗的入选标准:标准医学标准 + 患者及家庭辅助者进行自我透析的积极性、日常生活自理能力以及失明并非在成年前发生。CAPD设备:针对BD患者进行特殊改良的双袋系统。为患者/家庭辅助者制定了为期2周的专门培训计划,该计划针对BD患者进行了改良(无视觉辅助工具)。我们实现了尿毒症的完全临床和生化代偿;尿素清除率(KT/Vurea)> 1.9,每周肌酐清除率> 60 l/1.73平方米,超滤量(UF)> 400毫升。5例患者中有2例发生腹膜炎,发生率为1 : 28患者月。
对于1型糖尿病的BD患者,若患者有自我透析的积极性且培训计划针对他们进行了特殊改良,失明似乎并非CAPD治疗的限制因素,这类患者能够独立生活。