Continuous Ambulatory Peritoneal Dialysis in End-Stage Diabetic Nephropathy

  • Ramesh Khanna
  • Dimitrios G. Oreopoulos
Part of the Developments in Nephrology book series (DINE, volume 9)


Centers throughout North America are experiencing a remarkable rise in the proportion of newly diagnosed diabetic uremic patients requiring kidney replacement treatment [1–3]. Approximately 30% of all insulin-dependent (type I) diabetic patients die of renal failure. In the United States each year by conservative estimate, between 2,500 and 3,200 diabetics die of kidney disease [4]. Despite this large number, a decade ago diabetics with uremia comprised only 1–7% of all patients accepted for dialysis in Europe and the United States [5, 6]. These patients were excluded from dialysis for reasons that were multiple and complex, but the most important factors were the uniformly poor outcome of dialysis and transplantation [7–16], and the progressive deterioration of visual function. By 1978, however, due to technical advances in hemodialysis and better understanding of the factors contributing to the progression of diabetic complications, survival among chronically hemodialysed diabetics improved considerably [17–20].


Peritoneal Dialysis Continuous Ambulatory Peritoneal Dialysis Chronic Peritoneal Dialysis Continuous Ambulatory Peritoneal Dialysis Patient Blood Sugar Control 
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  1. 1.
    Friedman EA. Where are the data on America’s uremic diabetics: Diabetic Nephropathy 2: 3, 1983.Google Scholar
  2. 2.
    E.S.R.D. Network dialysis and transplant survival data 1981. 1982.Google Scholar
  3. 3.
    1981 End Stage Renal Disease Annual Report to Congress. Health care financing administration, HCFA 82–02144.Google Scholar
  4. 4.
    Knowles HC. Magnitude of the renal failure problem in diabetic patients. Kidney Int 6 (SI): 2–7, 1976.Google Scholar
  5. 5.
    Drukker W, Haagsma-Schouten WAG, Alberts CHR, Baarda B. Report on regular dialysis treatment in Europe VI. Proc Euro Dial Transplant Assoc 6: 133–135, 1971.Google Scholar
  6. 6.
    Kjellstrand CM. Dialysis in diabetics. In: Strategy in Renal Failure, Friedman EA (ed). New York: J. Wiley & and Sons, 1977, pp. 345–391.Google Scholar
  7. 7.
    Abella R, et al. Periodic dialysis in terminal uremia. JAMA 199: 362–368, 1967.PubMedCrossRefGoogle Scholar
  8. 8.
    Chazan BI, Rees SB, Balodimos MC, Younger D, Ferguson BD. Dialysis in diabetics: a review of 44 patients. JAMA 209: 2026–2030, 1969.PubMedCrossRefGoogle Scholar
  9. 9.
    Blagg CR, Eschback JW, Sawyer TK, Casaretto AA. Dialysis for endstage diabetic nephropathy. Proc Eur Dial Transplant Forum 1: 133–135, 1971.Google Scholar
  10. 10.
    Comty CM, Shapiro FL. Management and prognosis of diabetic patients treated by chronic hemodialysis. Am Soc Nephrol 5: 15, 1971.Google Scholar
  11. 11.
    Ghavamian M, Gutch CF, Kopp KF, Kolff WJ. The sad truth about hemodialysis in diabetic nephropathy. JAMA 222: 1386–1389, 1972.PubMedCrossRefGoogle Scholar
  12. 12.
    White N, Snowden SA, Parsons V, Sheldon J, Bewick M. The management of terminal renal failure in diabetic patients by regular dialysis therapy. Nephron 11: 261–275, 1973.PubMedCrossRefGoogle Scholar
  13. 13.
    Leonard A, Comty C, Raij L, Rattazzi T, Wathen RS, Shapiro F. The natural history of regularly dialyzed diabetics. Trans Am Soc Artif Intern Organs 19: 282–286, 1973.PubMedGoogle Scholar
  14. 14.
    Ma KW, Masler DS, Brown DC. Hemodialysis in diabetic patients with chronic renal failure. Ann Int Med 83: 215–217, 1975.PubMedGoogle Scholar
  15. 15.
    Shideman JR, Buselmeier TJ, Kjellstrand CM. Hemodialysis complications in insulin dependent diabetic patient accepted for transplantation. Arch Intern Med 136: 1126–1130, 1976.PubMedCrossRefGoogle Scholar
  16. 16.
    Avram MM, Slater PA, Fein PA, Altman E. Comparative survival of 673 patients with chronic uremia treated with renal transplantation (RT) and maintenance hemodialysis (MD). Trans Am Soc Artif Intern Organs 25: 391–393, 1979.PubMedGoogle Scholar
  17. 17.
    Comty C, Kuellsen D, Shapiro F. A reassessment of the prognosis of the diabetic patients treated by chronic hemodialysis. Trans Am Soc Artif Intern Organs 20: 286–296, 1978.Google Scholar
  18. 18.
    Ma K, Masler D, Brown D. Hemodialysis in diabetic patients with chronic renal failure. Ann Intern Med 83: 215–217, 1975.PubMedGoogle Scholar
  19. 19.
    Totten M, Izenstein B, Gleason R, et al. Chronic renal failure in diabetics. Survival with hemodialysis vs. transplantation. J Dial 2: 17–32, 1978.PubMedGoogle Scholar
  20. 20.
    Jacobs C, Rottembourg J, Frantz P, et al. Le traitment de l’insufficiance renale terminale du diabetique insulinodependent. In: Acutalitees Nephrologiques de L’Hopital Necker, Hamburger J, Grosnier J, Funk-Brentano J. (eds). Paris: Flammarion, 1978, p. 77.Google Scholar
  21. 21.
    Blumenkrantz M, Shapiro D, Mimura N, Oreopoulos DG, et al. Maintenance peritoneal dialysis as an alternative in the patients with diabetes mellitus and end stage uremia. Kidney Int (Suppl 1)6: 108–114, 1974.Google Scholar
  22. 22.
    Rubin J, Oreopoulos DG, Blair RG, et al. Chronic peritoneal dialysis in the management of diabetics with terminal renal failure. Nephron 19: 265–270, 1977.PubMedCrossRefGoogle Scholar
  23. 23.
    Katirtzoglou A, Izatt S, Oreopoulos DG, et al. Chronic peritoneal dialysis in diabetics with end stage renal failure. In: Diabetic Renal-Retinal Syndrome, Friedman EA, et al. (eds). New York: Grune & Stratton, 19??, pp. 317–332.Google Scholar
  24. 24.
    Mitchell J, Fronhert P, Kurtz S, Anderson C. Chronic peritoneal dialysis in juvenile onset diabetes mellitus. A comparison with hemodialysis. Mayo Clinic Proc 53: 775–781, 1978.Google Scholar
  25. 25.
    Mion C. A peritoneal dialysis programme. Proc Eur Dial Transpl Assoc 12: 140, 1975.Google Scholar
  26. 26.
    Rubin J, Oreopoulos DG, Blair G, et al. Chronic peritoneal dialysis in the management of diabetics with terminal renal failure. Nephron 19: 265, 1977.PubMedCrossRefGoogle Scholar
  27. 27.
    Blumenkrantz MJ, Kamdar AK, Coburn JW Peritoneal dialysis for diabetic patients with end stage nephropathy. Dial & Transpl 6: 47, 1977.Google Scholar
  28. 28.
    Blumenkrantz MJ, Shapiro DJ, Mimura, N, et al. Maintenance peritoneal dialysis as an alternative in the patient with diabetes mellitus and end-stage uremia. Kidney Int 1: S108, 1974.Google Scholar
  29. 29.
    Warden GS, Maxwell JG, Stephen RL. The use of reciprocating peritoneal dialysis with subcutaneous peritoneal catheter in end-stage renal failure in diabetes mellitus. J Surg Res 24: 495, 1978.PubMedCrossRefGoogle Scholar
  30. 30.
    Mion C, Slingeneyer A, Selam JL, et al. Home peritoneal dialysis (HPD) in end-stage diabetic nephropathy (ESDN) (Abstr.). J Dial 2: 426, 1978.Google Scholar
  31. 31.
    Quellhorst E, Schuenemann B, Mutzsch G, Jacob I. Hemo and peritoneal dialysis treatment of patients with diabetic nephropathy. A comparison study. Proc Eur Dial Transpl Assoc 15: 205, 1978.Google Scholar
  32. 32.
    Ghantous WN, Adelson BH, Salkin MS, et al. A comparison of peritoneal and hemodialysis in the treatment of diabetic and end-stage renal failure (Abstr.). J Dial 2: 436, 1978.Google Scholar
  33. 33.
    Flynn CT, Nanson JA. Intraperitoneal insulin in diabetes. Lancet Sept. 15: 591, 1969.Google Scholar
  34. 34.
    Flynn CT, Nanson JA. Intraperitoneal insulin with CAPD—an artificial pancreas. Trans Am Soc Artif Intern Organs 25: 114–117, 1979.PubMedGoogle Scholar
  35. 35.
    Schade DS, Eaton RP. 1980. The peritoneum—a potential insulin delivery route for a mechanical pancreas. Diabetes Care 3: 229, 1980.Google Scholar
  36. 36.
    Oreopoulos DG, Khanna R, Williams P, Vas SI. Continuous ambulatory peritoneal—1981. Nephron 30: 293–303, 1982.PubMedCrossRefGoogle Scholar
  37. 37.
    Nolph KD. Continuous ambulatory peritoneal dialysis. Am J Nephrol 1: 1–10, 1981.PubMedCrossRefGoogle Scholar
  38. 38.
    Mion C, Slingeneyer A, Canaud B, Elie M. A review of seven years home peritoneal dialysis. Proc EDTA 18: 91–110, 1981.Google Scholar
  39. 39.
    Flynn T. Continuous ambulatory peritoneal dialysis in diabetic patients. Proceedings of the 1st International Symposium on CAPD. Excerpta Medica, Amsterdam 187, 1980.Google Scholar
  40. 40.
    Kuhlmann H, Thomae U. CAPD—an alternative in the dialysis treatment of diabetics suffering from kidney failure? Med Welt 31: 1140, 1980.PubMedGoogle Scholar
  41. 41.
    Amair P, Khanna R, Leibel B, et al. Continuous ambulatory peritoneal dialysis in diabetics with end-stage renal disease. N Engl J Med 306: 625, 1982.PubMedCrossRefGoogle Scholar
  42. 42.
    Flynn CT. Diabetes and CAPD. Int J Artif Organs 5, 332–333, 1982.PubMedGoogle Scholar
  43. 43.
    Legrain M, Rottembough J, Bentchikou A, et al. Dialysis treatment of insulin dependent diabetic patients: ten years experience. Clin Nephrology 21: 72–81, 1984.Google Scholar
  44. 44.
    Khanna R, Oreopoulos DG. Peritoneal access using the Toronto Western Hospital permanent catheter. Perspect Perit Dial 1; 4–7, 1983.Google Scholar
  45. 45.
    Khanna R Oreopoulos DG, Dombros N, et al. Continuous ambulatory peritoneal dialysis after three years: still a promising treatment. Perit Dial Bull 1: 24, 1981.Google Scholar
  46. 46.
    Porte D Jr, Bagdade JD. Human insulin secretion: an integrated approach. Annu Rev Med 21: 219–240, 1970.PubMedCrossRefGoogle Scholar
  47. 47.
    Flynn CT Hibbard J, Dohrman B. Advantages of continuous ambulatory peritoneal dialysis to the diabetic with renal failure. Proc EDTA 16: 184–193, 1979.Google Scholar
  48. 48.
    Editorial. New insulin delivery system for diabetics. Lancet 1 (June): 1275–1277, 1979.Google Scholar
  49. 49.
    Greenwood RH, Davies CJ, Senator GB, et al. Intraperitoneal insulin in diabetics. Lancet 2: 312, 1979.PubMedCrossRefGoogle Scholar
  50. 50.
    Flynn CT, Nanson JA. Intraperitoneal insulin in diabetics. Lancet 2: 591, 1979.PubMedCrossRefGoogle Scholar
  51. 51.
    Graber AL. Chronic peritoneal dialysis in insulin dependent diabetes mellitus—diabetic clinical care conference. J Tenn Med Assoc 2: 74, 1981.Google Scholar
  52. 52.
    Schade DS, Eaton RP, et al. Five day programmed intraperitoneal insulin infusion in diabetic man. Abstract Am Diabetic Assoc, p. 71, 1980.Google Scholar
  53. 53.
    Schade DS, Eaton RP, Spencer W. The advantages of the peritoneal route of insulin delivery. In: Irsigler K., Kunz D., Owens, D., Regal, H. (Eds) New Approaches to Insulin Therapy. MTP Press, Lancaster 1981.Google Scholar
  54. 54.
    Zingg W, Shirriff JM, Liebel. Experimental routes of insulin administration. Perit Dial Bull 2: S24–27, 1982.Google Scholar
  55. 55.
    Balducci A, Slama G, Rottembourg J, Baumelou A, Delage A. Intraperitoneal insulin in uraemic diabetics undergoing continuous ambulatory peritoneal dialysis. Br Med J 283: 1021– 1023, 1981.Google Scholar
  56. 56.
    Shapiro DJ, Blumenkrantz MJ, Levin SR, Coburn JW. Absorption and action of insulin added to peritoneal dialysate in dogs. Nephron 23: 174–180, 1979.PubMedCrossRefGoogle Scholar
  57. 57.
    Brachet E, Rasio E. The passage of (1251) insulin across isolated mensentery. Effect of anti-insulin serum, Biochim Biophys Acta., 183: 162–168, 1969.PubMedCrossRefGoogle Scholar
  58. 58.
    Twardowski ZJ, et al. Insulin binding to plastic bags: a methodologic study. Am J Hosp Pharm 40: 575–579, 1983.PubMedGoogle Scholar
  59. 59.
    Twardowski ZJ, et al. Nature of insulin binding to plastic bags. Am J Hosp Pharm 40: 579–582, 1983.PubMedGoogle Scholar
  60. 60.
    Twardowski ZJ, et al. Influence of temperature and time on insulin adsorption to plastic bags. Am J Hosp Pharm 40: 583–586, 1983.PubMedGoogle Scholar
  61. 61.
    Twardowski ZJ Insulin adsorption to peritoneal dialysis bags. Perit Dial Bull 3: 113–115, 1983.Google Scholar
  62. 62.
    Johnson CA, et al. Adsorption of insulin to the surface of peritoneal dialysis solution containers. Am J Kidney Disease 3: 224–228, 1983.Google Scholar
  63. 63.
    Silver MR, Sorkin MI. Insulin delivery from continuous ambulatory peritoneal dialysis bags used with peridex filters. Perit Dial Bull 4: 23–27, 1984.Google Scholar
  64. 64.
    Blumenkrantz MJ, Salehmghaddan S, Salusky I. Treatment of patients with end-stage diabetic nephropathy. In: Peritoneal Dialysis, LaGreca G, et al. (eds). Milano, Italy: Wichtig, Editor, 1983, pp. 289–306.Google Scholar
  65. 65.
    Khanna R, Liebel B. The Toronto Western Hospital protocol. What is the protocol for control of blood sugar in diabetics on CAPD? Perit Dial Bul 1: 100–101, 1981.Google Scholar
  66. 66.
    Rottembourg J, Caryon A, Benoliel D, Pelluzo F, Ozzanne P. Critical evaluation of the injection site for insulin in CAPD diabetic patient. Perit Dial Bull 4: S55, 1984.Google Scholar
  67. 67.
    Reeves ML, Forhan SE, Skyler JS, Peterson CM. Comparison of methods for blood glucose monitoring. Diabetes Care 4: 404–406, 1980.Google Scholar
  68. 68.
    Khanna R, Wu G, Chisholm L, Oreopoulos DG. Further experience with CAPD in diabetics with end-stage renal disease. In: Prevention and Treatment of Diabetic Nephropathy, Keen H, Legrain M. (eds). Boston: MTP Press Limited, 1983, pp. 279–288.Google Scholar
  69. 69.
    Lameire N, Dhaene M, Matthigs E, et al. Experience with CAPD in diabetic patients. In: Prevention and Treatment of Diabetic Nephropathy, Keen H, Legrain M. (eds). Boston: MTP Press Limited, 1983, pp. 289–297.Google Scholar
  70. 70.
    Coronel F, Naranjo P, Prats D. A year of experience of CAPD in the diabetic and non-diabetic patient. In: Prevention and Treatment of Diabetic Nephropathy, Keen H, Legrain M. (eds). Boston: MTP Press Limited, 1983, pp. 315–332.Google Scholar
  71. 71.
    Grefberg N, Danielson BG, Nilsson P. Continuous ambulatory peritoneal dialysis in the treatment of end-stage diabetic nephropathy. Acta Medica Scand 215: 427–434, 1984.CrossRefGoogle Scholar
  72. 72.
    Rottembourg J, Shahat EL, Agrafiotis A, et al. CAPD in insulin dependent diabetic patients, and a 40 month experience. Kidney Int 23: 40, 1983.PubMedCrossRefGoogle Scholar
  73. 73.
    Graft RJ, Porte DJ. Glycosylated hemoglobin as an index of glycemia independent of plasma insulin in normal and diabetic subjects. Diabetes 27: 368, 1977.Google Scholar
  74. 74.
    Boer MJ, Miedema K, Casparie AF. Glycosylated hemoglobin in renal failure. Diabetologia 18: 437–440, 1980.PubMedCrossRefGoogle Scholar
  75. 75.
    Serkes K. Travenol Laboratories, Deerfield, Illinois, Personal communication.Google Scholar
  76. 76.
    Popovich RP, Moncrief JW, Nolph KD, et al. Continuous ambulatory peritoneal dialysis. Ann Intern Med 88: 449, 1978.PubMedGoogle Scholar
  77. 77.
    Oreopoulos DG, Robson M, Izatt S, et al. A simple and safe technique for continuous ambulatory peritoneal dialysis. Trans Am Soc Artif Intern Organs, 1978, pp. 484–487.Google Scholar
  78. 78.
    Slingeneyer A, Mion C, Despaux E, et al. Use of bacteriologic filter in the prevention of peritonitis associated with peritoneal dialysis: long-term clinical results in intermittent and continuous ambulatory peritoneal dialysis. In: Peritoneal Dialysis, Atkins RC, et al. (eds). Edinburgh: Churchill Livingston, 1981, pp. 114–125.Google Scholar
  79. 79.
    Oreopoulos DG, Zellerman G, Izatt S. The Toronto Western Hospital permanent peritoneal catheter and continuous ambulatory peritoneal dialysis connector. In: Continuous Ambulatory Peritoneal Dialysis, Legrain M. (ed). Amsterdam: Excerpta Medica, 1980, pp. 73–78.Google Scholar
  80. 80.
    Williams C, and the University of Toronto Collaboratory Dialysis Group. CAPD in Toronto —an overview. Perit Dial Bull 35: 2–6, 1983.Google Scholar
  81. 81.
    Flynn CT. The diabetic patient on continuous ambulatory peritoneal dialysis. Perit Dial Bull 351: 16–20, 1983.Google Scholar
  82. 82.
    Slingeneyer A, Mion C, Selam JL. Home intermittent and CAPD as a long term treatment of end-stage renal failure in diabetics. In: Advances in Peritoneal Dialysis, Gahl GM, et al. (eds). Amsterdam: Excerpta Medica, 1981, pp. 378–388.Google Scholar
  83. 83.
    Grefberg N. Clinical aspects of continuous ambulatory peritoneal dialysis. Scand J Uro, Nephrol 72: S7 - 38, 1983.Google Scholar
  84. 84.
    Madden MA, Zimmerman SW, Simpson DP CAPD in diabetes mellitus. Am J Nephrol 2: 133–139, 1982.PubMedCrossRefGoogle Scholar
  85. 85.
    Ponce SP, et al. Comparison of the survival and complications of the permanent peritoneal dialysis catheters. Perit Dial Bull 2: 82, 1982.Google Scholar
  86. 86.
    Dombros N, Oven A, Marliss EB, et al. Plasma amino acid profiles and amino acid losses in patients undergoing CAPD. Perit Dial Bull 2: 27 - 32, 1982.Google Scholar
  87. 87.
    Giordano C, DeSanto NG, Capodicase G, et al. Amino acid losses during CAPD. Clin Nephrol 14: 230–232, 1980.PubMedGoogle Scholar
  88. 88.
    Randerson D, Chapman GV, Farrel PC. Amino acid and dietary status in CAPD patients. In:Peritoneal Dialysis, Atkins RC, et al. (eds). New York: Churchill Livingston, 1981, pp. 179–191.Google Scholar
  89. 89.
    Moncrief JW, Pyle WK, Simon P, Popovich RP. Hypertriglyceridemia, diabetes mellitus, and insulin administration in patients undergoing CAPD. In: CAPD Update, Moncrief J W, et al. (eds). New York: Mason Publishing, 1981, pp. 143–165.Google Scholar
  90. 90.
    Beardsworth SF, Goldsmith HJ, Stanbridge BR. Intraperitoneal insulin cannot correct the hyperlipidemia of CAPD. Perit Dial Bull 3: 126–128, 1983.Google Scholar
  91. 91.
    Khanna R, Breckenridge C, Roncari D, Digenis G, Oreopoulos DG. Lipid abnormalities in patients undergoing continuous ambulatory peritoneal dialysis. Perit Dial Bull 35: 13–15, 1983.Google Scholar
  92. 92.
    Faller B, Marichal JD. Loss of ultrafiltration in CAPD. Clinical data. In: Advances in Peritoneal Dialysis, Gahl G, Kessel M, Nolph KD. (eds). Amsterdam: Exerpta Medica, 1981, pp. 227–232.Google Scholar
  93. 93.
    Slingeneyer A, Canaud B, Mion C. Permanent loss of ultrafiltration capacity of the peritoneum in long-term peritoneal dialysis. Nephron 33: 133–138, 1983.PubMedCrossRefGoogle Scholar
  94. 94.
    Rottembourg J, Issad B, Poignet JL, et al. Residual renal function and control of blood glucose levels in insulin-dependent diabetic patients treated by CAPD. In: Prevention and Treatment of Diabetic Nephropathy, Keen H, Legrain M. (eds). Boston: MTP Press Ltd, 1983, pp. 339–352.Google Scholar
  95. 95.
    Shapiro FL, Comty CM. Hemodialysis in diabetics—1981 update. In: Diabetic Renal—Retinal Syndrome, Friedman EA, et al. (eds). New York: Grune & Stratton, 1982, pp. 309 - 320.Google Scholar
  96. 96.
    Kurtz SB, Wong VH, Anderson CF, et al. Continuous ambulatory peritoneal dialysis. Three years experience at the Mayo Clinic. Mayo Clinic Proc 58: 633–639, 1983.Google Scholar
  97. 97.
    Nolph KD, et al. Personal communication.Google Scholar
  98. 98.
    Wing AF, Broyer M, Brunner FP, et al. Combined report on regular dialysis and transplantation in Europe 1982. Proc EDTA, ERA, 1983. 20: 1–78, 1983.Google Scholar
  99. 99.
    Flynn CT. The diabetics on CAPD. In: Diabetic Renal-Retinal Syndrome, Friedman EA, et al. (eds). New York: Grune and Stratton, 1983, pp. 321–330.Google Scholar
  100. 100.
    Doughty MC, Pierie KG. Continuous ambulatory peritoneal dialysis and the blind patient. Nephrol Nurse 3: 11, 1981.PubMedGoogle Scholar
  101. 101.
    Knotek B. Independence for the visually impaired continuous ambulatory peritoneal dialysis (CAPD) patient. AANNT J 9: 69–71, 1982.PubMedGoogle Scholar
  102. 102.
    Kelman B. Diabetes and the blind new methods. New treatments. Renal Family: 35–41, 1983.Google Scholar

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© Martinus Nijhoff Publishing, Boston 1986

Authors and Affiliations

  • Ramesh Khanna
  • Dimitrios G. Oreopoulos

There are no affiliations available

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