[Treatment of chronic renal insufficiency in the diabetic by dialysis and transplantation].

The number of diabetics with end stage renal disease (ESRD) is growing. The best treatment at the lowest cost possible should be offered to all diabetics if therapeutic facilities are available. Such a policy requires that all dialysis methods and transplantation should be available and that transfer from one method to another should always be allowable. Results observed among insulin and non insulin-dependent diabetics are improving steadily, even in the older age group. However they are inferior to those observed in non diabetic people of the same age. Adequate medical care, including excellent control of high blood pressure and good control of blood glucose levels should reduce the frequency of severe complications including cardiac, ocular and peripheral vascular lesions. In diabetic patients under forty years of age, renal transplantation using a kidney from a cadaver or a related donor should be the first choice. However, for most patients dialysis methods are required as the only treatment or while waiting for a transplant. Very encouraging results are obtained with both hemodialysis and peritoneal dialysis. If home dialysis is considered, continuous ambulatory peritoneal dialysis (CAPD) offers the opportunity to treat many insulin-dependent or non dependent diabetics at home even those in the high risk population because of age and/or cardio-vascular instability. CAPD offers excellent control of blood glucose levels using the intraperitoneal route to administer insulin. Results obtained are discussed from data in the literature and from a survey of 124 insulin-dependent diabetic cases with ESRD treated in the Department of Nephrology of the Hospital de La Pitié from 1973 to 1984.