Hemodynamics in diabetic renal failure.

Cardiac performance was assessed by left ventricular catheterization in ten insulin-dependent diabetics with non-dialysis-requiring uremia. None of the patients had a history or clinical signs of ischemic or valvular heart disease or congestive heart failure. Cardiac output at rest was normal in all patients. During exercise, one patient had somewhat low cardiac output and nine showed impaired ability to increase stroke work. This impairment was accompanied by elevation of the left ventricular end-diastolic pressure. The abnormal cardiac performance could not be ascribed to the degree of anemia or uremia or to volume overload. Arterial hypertension possibly contributed. The observations suggest that in diabetic patients with moderate uremia there is also left ventricular dysfunction. Renal transplantation should therefore be considered for these patients earlier than is customary for uremics without diabetes.