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Nephrol Dial Transplant (1993) 8: 725-734
© 1993 European Renal Association-European Dialysis and Transplant Association

research-article

Long-term follow-up study of 268 diabetic patients undergoing haemodialysis, with special attention to visual acuity and heterogeneity

Y. Watanabe1,, Y. Yuzawa1, D. Mizumoto1, H. Tamai1, Y. Itoh2, S. Kumon3 and C. Yamazaki4

1Nagoya University School of Medicine, Third Department of Internal Medicine Nagoya 2Chubu Industrial Hospital Nagoya 3Tousei Public Hospital Seto 4Masuko Memorial Hospital Nagoya, Japan

Correspondence and offprint requests to: Correspondence and offprint requests to: Yuzo Waianabe MD, Nagoya University School of Medicine, Third Department of Internal Medicine, 65 Tsurumai, Showa-ku, Nagoya, Japan, 466.

We studied the long-term outcome of 268 patients suffering from diabetic end-stage renal disease (DM-ESRD) treated with long-term haemodialysis between 1978 and 1991, with special emphasis on visual acuity as well as the heterogeneity of DM-ESRD The 50% patient survival on haemodialysis was 60 months. Visual disturbances were found in 73.1% (392/536) of eyes at the start of haemodialysis. Chronological assess ment of visual acuity demonstrated the stabilization of visual acuity and 87.1% (364/418) of eyes were stable, 4.8% (20/418) were improved, and 8.1% (34/418) were aggravated in the long term respectively. The change of visual acuity was frequently seen in the short term, and rapid shifts of body fluid to correct overhydration induced abrupt changes of glycaemic control as well as retraction of macular oedema. Hence it might be one of the factors affecting rapid change of visual acuity in the short term. Meanwhile, long-term deteri oration of visual acuity resulted from either hyperten sion unresponsive to medical treatment or poor glycaemic control. Some DM-ESRD patients had only background retinopathy at the start of haemodialysis and these were likely to have the nephrosclerotic glomerular lesion. They were old, not nephrotic and had a mild degree of diabetes during the predialysis stage. Thus, DM-ESRD patients seem to have some heterogeneity in their clinical characteristics, and old DM-ESRD patients with only background retinopathy have the appearance of diabetic macroangiopathy rather than microangiopathy.

Keywords: chronic renal failure; diabetic retinopathy; diabetic nephropathy; haemodialysis; rehabilitation


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