Schmitz O, Hansen H E, Orskov H, Mogensen C E, Posborg Petersen V
Blood Purif. 1985;3(1-3):120-39. doi: 10.1159/000169405.
Forty percent of patients with insulin-dependent diabetes will develop nephropathy during the course of their disease, thus being the most important single disorder leading to end-stage renal failure (ESRF). Intensive metabolic control delays onset of diabetic nephropathy, the first omen of which is appearance of subclinical albuminuria, also termed microalbuminuria. Moreover, it is now established that intensive treatment of hypertension reduces rate of decline in GFR and thus postpones ESRF. When uremia eventually sets in, a range of biochemical and endocrine abnormalities can be included among those characteristics of diabetes mellitus per se. These include elevated plasma levels of growth hormone, glucagon and free fatty acids, which may participate in the uremic insulin resistance superimposed on the preexisting diabetic carbohydrate intolerance. Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are two established modalities of renal replacement therapy in diabetes mellitus. Controlled clinical trials for comparison of CAPD versus HD treatment of diabetics are, however, still needed. The survival rate is approximately 80 and 65-95% in insulin-dependent diabetic patients at 1 year during treatment with HD and CAPD, respectively. However, it is general experience that diabetics on CAPD exhibit a glycemic control, superior to that attained during HD. It has not been proved that patient survival after cadaveric renal transplantation is better than on dialysis. The degree of vascular heart disease seems to be the major determinant for survival of kidney-transplanted diabetic patients.
40%的胰岛素依赖型糖尿病患者在病程中会发展为肾病，这是导致终末期肾衰竭（ESRF）的最重要的单一病症。强化代谢控制可延缓糖尿病肾病的发生，其首个征兆是亚临床白蛋白尿的出现，也称为微量白蛋白尿。此外，现已证实强化高血压治疗可降低肾小球滤过率（GFR）的下降速率，从而推迟ESRF的发生。当最终出现尿毒症时，一系列生化和内分泌异常可被纳入糖尿病本身的特征之中。这些异常包括血浆生长激素、胰高血糖素和游离脂肪酸水平升高，它们可能参与了叠加在已存在的糖尿病碳水化合物不耐受之上的尿毒症胰岛素抵抗。血液透析（HD）和持续性非卧床腹膜透析（CAPD）是糖尿病患者已确立的两种肾脏替代治疗方式。然而，仍需要进行对照临床试验以比较CAPD与HD治疗糖尿病患者的效果。在HD和CAPD治疗期间，胰岛素依赖型糖尿病患者1年时的生存率分别约为80%和65 - 95%。然而，一般经验表明，接受CAPD治疗的糖尿病患者血糖控制优于HD治疗期间。尚未证实尸体肾移植后患者的生存率优于透析治疗。血管性心脏病的程度似乎是肾移植糖尿病患者生存的主要决定因素。
