Tzamaloukas A H, Yuan Z Y, Balaskas E, Oreopoulos D G
Renal Section, VA Medical Center, Albuquerque, NM 87108.
Adv Perit Dial. 1992;8:185-91.
Large numbers of diabetics with renal failure have been treated by continuous ambulatory peritoneal dialysis (CAPD). Overall 1-year patient survival varies from 51% to 87%. Mortality is due to cardiovascular disease in more than 50% of the cases. Young diabetics with good blood pressure control and without cardiac disease have a chance at long survival on CAPD. In comparison to hemodialysis, CAPD yields better patient survival for young diabetics and worse for old diabetics, worse technique survival, probably greater overall morbidity, and similar rates of progression of retinopathy, neuropathy and peripheral vascular disease. Adequacy of peritoneal clearance and peritoneal ultrafiltration characteristics are similar between diabetics and non-diabetics on CAPD. CAPD is associated with better preservation of renal function than hemodialysis in diabetics. The rates of CAPD peritonitis do not differ substantially between diabetics and non-diabetics. However, diabetes appears to be associated with higher incidence of tunnel infection. Hyperlipidemia is generally less severe in diabetics than non-diabetics on CAPD, but malnutrition is more frequent in diabetics. CAPD has many attractive features and several drawbacks for the management of diabetics with end stage renal failure (ESRF). Its ultimate success will depend on the outcome of efforts to improve cardiovascular mortality, malnutrition, hyperlipidemia and catheter-related infections.
大量肾衰竭糖尿病患者已接受持续非卧床腹膜透析（CAPD）治疗。总体而言，患者1年生存率在51%至87%之间。超过50%的病例死亡原因是心血管疾病。血压控制良好且无心脏病的年轻糖尿病患者通过CAPD有长期存活的机会。与血液透析相比，CAPD对年轻糖尿病患者的生存率更高，对老年糖尿病患者则更低，技术生存率更低，总体发病率可能更高，视网膜病变、神经病变和外周血管疾病的进展率相似。在接受CAPD治疗的糖尿病患者和非糖尿病患者之间，腹膜清除率和腹膜超滤特性相似。在糖尿病患者中，与血液透析相比，CAPD与更好地保留肾功能相关。糖尿病患者和非糖尿病患者的CAPD腹膜炎发生率没有显著差异。然而，糖尿病似乎与隧道感染的较高发生率相关。在接受CAPD治疗的患者中，糖尿病患者的高脂血症通常不如非糖尿病患者严重，但糖尿病患者营养不良更为常见。对于终末期肾衰竭（ESRF）糖尿病患者的管理，CAPD有许多吸引人的特点和一些缺点。其最终成功将取决于改善心血管疾病死亡率、营养不良、高脂血症和导管相关感染的努力结果。
