Hemodialysis is resorted to when
the kidney function of filtering the blood and producing urine goes down below
10 to 15 percent or when the kidney does not function at all (called the
end-stage renal disease or ESRD). This is a therapy where the blood is removed
from the body and filtered through an 'artificial kidney' (a machine that helps
to purify the blood) and then the 'purified' blood is returned to the body. The
therapy helps in removing waste products
and extra fluid, and maintains
balance of electrolytes such as sodium, potassium, chloride and calcium.
A proper diet also helps reduce
the waste products that build up in the blood.
One of the complications of long
term diabetes is the end stage renal disease. Pancreatic diabetes mellitus
(PDM) is a metabolic form of diabetes in which the pancreas is extensively
damaged. One to eight percent of diabetic patients with end-stage renal
disease (ESRD) suffer from diabetic nephropathy (dNP) due to pancreatic
However, not much information is available that deals
with pancreatic diabetes and ESRD. So, Gert Bodlaj and Georg Biesenback from
the Department of Medicine, General Hospital Linz, Austria, conducted a study
to investigate differences in the clinical outcome of the ERSD patients due to
pancreatic diabetes or type2 diabetes. Type 2 diabetes usually results
due to a resistance of the body cells to the action of insulin.
The researchers evaluated 96
diabetic patients who started hemodialysis in their dialysis center, of
which 12 were diagnosed with pancreatic diabetes and the rest 84 patients were
diagnosed with type2 diabetes.
Comparative studies were done on
vascular risk factors and prevalence of vascular disease in both groups at the
start of hemodialysis. Incidence of malnutrition and 5-year survival rates was
evaluated in both groups.
The observation period of the study was five years.
Results showed that:
• The vascular risk factors were similar in both groups.
• Cholesterol was lower in the PDM patients.
• The HbA1c values were not different, however, the
patients with PDM required significantly less insulin.
• The prevalence of vascular diseases at the start
of dialysis was not significantly different between the two groups.
• The nutritional status at the start of hemodialysis was
poor in the PDM patients. The frequency of underweight (BMI less than
21) was 50 percent in those patients versus 9 percent in those with type 2
• Death due to cardiovascular disease was 60 percent in
the PDM group and 65 percent in the type 2 group. Infection was cause of death
in 27 percent of the PDM patients and 21 percent of the patients with type 2
The study has limitations because of the small number of
PDM patients (12 compared to 84 with type 2 diabetes), the absence of data on
residual renal function, and the absence of more accurate methods of
The authors concluded - 'The prevalence of vascular
diseases is not significantly different in both, patients on hemodialysis with
PDM versus type 2 diabetes. The lower
survival of PDM patients can be related to poor nutrition status'.
Reference: Biesenbach G, Bodlaj G. Higher mortality of patients
on haemodialysis with pancreatic diabetes compared to type 2-diabetes. Diabetol
Metab Syndr. 2012 Mar 23;4(1):9.