Rottembourg J, Issad B, Allouache M, Ruotolo C, Deray G, Baumelou A, Kahn J F, Jacobs C
Service de Néphrologie, Groupe hospitalier Pitié-Salpêtrière, Paris.
Nephrologie. 1988;9(5):227-32.
The treatment of end stage renal diabetic nephropathy remains a challenge. A large experience allows us to clearly outline the advantages and the drawbacks of continuous ambulatory peritoneal dialysis (CAPD). 81 patients, mean age 51.3 years, were treated over the past nine years by CAPD-CCPD. Extrarenal complications, mainly vascular lesions, account for qualifying these patients as a high risk population. The technique was modified in order to inject insulin intraperitoneally, four times per day, to control blood glucose level. Peripheral vascular disease was prospectively studied in 19 patients. Actuarial survival was 92% at one year, 50% at four years mainly influenced by age: 85% survival at two years in 35 patients aged less than 50 years and 62% at two years in 46 patients aged more than 50 years. The main causes of death were of cardiovascular origin: arteritis, myocardial infarction, stroke. The main causes for transfer to an alternative method of treatment were technical complications. Peritonitis rate was one episode ever 14 months. Satisfactory control of blood pressure, blood glucose levels, main biological parameters, visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPD can be the technique of first choice in young diabetics awaiting a kidney transplant and the reference technique for home dialysis.
终末期糖尿病肾病的治疗仍然是一项挑战。丰富的经验使我们能够清晰地勾勒出持续非卧床腹膜透析（CAPD）的优缺点。在过去九年中，81例平均年龄为51.3岁的患者接受了CAPD-CCPD治疗。肾外并发症，主要是血管病变，使这些患者被归为高危人群。为了控制血糖水平，对该技术进行了改进，每天经腹膜注射胰岛素四次。对19例患者的外周血管疾病进行了前瞻性研究。一年时的精算生存率为92%，四年时为50%，主要受年龄影响：35例年龄小于50岁的患者两年生存率为85%，46例年龄大于50岁的患者两年生存率为62%。主要死亡原因是心血管源性的：动脉炎、心肌梗死、中风。转为其他治疗方法的主要原因是技术并发症。腹膜炎发生率为每14个月1次。该方法的明显优点是能令人满意地控制血压、血糖水平、主要生物学参数和视力状况。外周血管疾病不受该技术影响。CAPD可以成为等待肾移植的年轻糖尿病患者的首选技术和家庭透析的参考技术。
