Maintenance dialysis for diabetic nephropathy with uremia

Fourteen patients, aged 28-61 yr, with diabetic nephropathy and uremia were observed on maintenance dialysis for a total of 156.5 dialysis patient months (range: 1.5-30 months per patient). Clinical course on dialysis was eventful in most cases, though nitrogen retention and acidosis were readily controlled. Bouts of circulatory congestion and severe fluid retention were frequent in nine patients, six of whom died of acute myocardial infarction or intractable heart failure. Septic complications and hepatitis caused or contributed to the demise of four patients, and thromboembolic complications to that of one patient. Rehabilitation on dialysis was limited in nine cases, and five remained disabled. Retinopathy was not improved. Emotional problems were common in nine patients, five of whom required psychiatric care. Ten patients died between 1.5 and 21 months after the start of dialysis, and only one survived over 30 months. Three patients underwent renal transplantation 6 to 18 months after inception of dialysis. They all died 10 days to 3 months after surgery of overwhelming septic complications. Survival rate on maintenance dialysis for the whole group was 54.8 per cent at 1 yr, and 16.4 per cent at 2 yr.