Diabetics

[Danally]

My dad is a diabetic and he has been on dialysis for 3-months. I have heard that diabetics do not do well on dialysis. I would like any information about diabetics on dialysis. His labs have been good so far.

[livecam]

My dad is a diabetic and he has been on dialysis for 3-months. I have heard that diabetics do not do well on dialysis. I would like any information about diabetics on dialysis. His labs have been good so far.

Hi Danally,

I'm diabetic and I think I did well on dialysis although I hated almost every minute of it.  Dialysis can actually ease some of the symptoms of diabetes because meds tend to stay in the body longer.  I was on oral meds for diabetes then and had very well controlled blood sugars most of the time.

Try to help him follow the rules about diet and fluid intake and he should be fine.  Diabetes is also no barrier to a transplant so he should be working on getting listed for a cadaveric kidney and even better you family members can be thinking about donating a kidney to him.

Good luck!

[goofynina]

From what i understand, most of the patients on dialysis are diabetics, i know i am one,   although i hated hemo and felt like crap,  maybe i should've listened to them when they told me to watch my diet and fluid intake huh?    Now that i am on PD, i am feeling so much better,     Good luck to you and your dad,  Godspeed. 

[Chicken Little]

I am an insulin dependant diabetic and was also told dialysis is harder on diabetics and like Goofynina, I also felt better on PD than I do on Hemo. 

My transplant team jumped through hoops to quickly get me on the pancreas/kidney list, due to the shorter wait time.  I've heard them say a couple times that they want me off dialysis ASAP.

[jbeany]

I'm diabetic and on dialysis.  What part are we not supposed to do well at?  I can think of a couple reasons that docs would say that - I know the diet can be a lot more complicated for a diabetic, at least if the person doesn't have the option to adjust insulin levels to account for the higher carbs on the renal diet.  Our risk of cardiac problems is pretty high in the first place, so I suppose the added cardiac risk from the fluid retention that goes with dialysis doesn't help our odds much. Maybe they just figure if your diabetic control was so bad that you ended up in kidney failure, then the control is only going to get worse on dialysis?

[Chicken Little]

I wear an insulin pump and my BS control is actually really good.  I don't know what the concern is.  Cardiac issues would be my guess, but I don't have problems there yet either.  I'll ask next time I see them. 

[Zach]

Maybe they just figure if your diabetic control was so bad that you ended up in kidney failure, then the control is only going to get worse on dialysis?

You may be right, JB. 

[Danally]

I think the cardiac risk is higher when you are a diabetic.

[Bajanne]

I think the cardiac risk is higher when you are a diabetic.

This might be true, because my brother who was diabetic and on dialysis died of a heart attack after 10 years of dialysis.  What is strange, though, is that after a time on dialysis, he no longer needed diabetic medication.
I am finding that my diabetes is more under control, even without medication, now I am on dialysis.  What have you other diabetics experienced?

[stauffenberg]

Diabetics do extremely poorly on dialysis, and their average life expectancy on dialysis is less than half that of non-diabetics on dialysis.  In part this is because the kidneys function as a 'second pancreas,' in that they remove excess sugar from the blood fairly quickly when they are functioning.  When they are not, the sugar accumulates and does more damage.  Also, the complications caused by the inadequate renal function of patients on dialysis, such as accelerated neuropathy, arteriosclerosis, atherosclerosis, and limb loss, duplicated and intensify many of the complications of diabetes.  In my own experience on dialysis, I have watched diabetic patients go blind or become multiple amputees in just a few years after starting therapy.  This is one of the reasons some centers are now adopting a policy of giving diabetics preference in the waiting list for transplants, given their poor prognosis on dialysis.

[livecam]

Diabetics do extremely poorly on dialysis, and their average life expectancy on dialysis is less than half that of non-diabetics on dialysis.  In part this is because the kidneys function as a 'second pancreas,' in that they remove excess sugar from the blood fairly quickly when they are functioning.  When they are not, the sugar accumulates and does more damage.  Also, the complications caused by the inadequate renal function of patients on dialysis, such as accelerated neuropathy, arteriosclerosis, atherosclerosis, and limb loss, duplicated and intensify many of the complications of diabetes.  In my own experience on dialysis, I have watched diabetic patients go blind or become multiple amputees in just a few years after starting therapy.  This is one of the reasons some centers are now adopting a policy of giving diabetics preference in the waiting list for transplants, given their poor prognosis on dialysis.

As always Stauffenberg gives us his uniquely optimistic take on diabetes and kidney disease.  Excuse me while I walk on my two legs and two feet to the other side of the lot so that I can do some fine color matching of live cameras with my blind eyes.

[Danally]

Diabetics do extremely poorly on dialysis, and their average life expectancy on dialysis is less than half that of non-diabetics on dialysis.  In part this is because the kidneys function as a 'second pancreas,' in that they remove excess sugar from the blood fairly quickly when they are functioning.  When they are not, the sugar accumulates and does more damage.  Also, the complications caused by the inadequate renal function of patients on dialysis, such as accelerated neuropathy, arteriosclerosis, atherosclerosis, and limb loss, duplicated and intensify many of the complications of diabetes.  In my own experience on dialysis, I have watched diabetic patients go blind or become multiple amputees in just a few years after starting therapy.  This is one of the reasons some centers are now adopting a policy of giving diabetics preference in the waiting list for transplants, given their poor prognosis on dialysis.

Does anyone know if this is really true?

[Sluff]

Diabetics do extremely poorly on dialysis, and their average life expectancy on dialysis is less than half that of non-diabetics on dialysis.  In part this is because the kidneys function as a 'second pancreas,' in that they remove excess sugar from the blood fairly quickly when they are functioning.  When they are not, the sugar accumulates and does more damage.  Also, the complications caused by the inadequate renal function of patients on dialysis, such as accelerated neuropathy, arteriosclerosis, atherosclerosis, and limb loss, duplicated and intensify many of the complications of diabetes.  In my own experience on dialysis, I have watched diabetic patients go blind or become multiple amputees in just a few years after starting therapy.  This is one of the reasons some centers are now adopting a policy of giving diabetics preference in the waiting list for transplants, given their poor prognosis on dialysis.

Thanks for your input but could you find any articles to prove your claim? I have diabetes but I'm not yet on dialysis. My kidney disease was not caused by my diabetes but i do have neuropathy.

[stauffenberg]

You can find all the data about the poor prognosis for diabetics on dialysis in Gabriel Danovitch's book, Handbook of Kidney Transplantation, Philadelphia: Lippincott, 2001, which I have often cited on this forum before.

I went through nine years of dialysis as a type 1 diabetic, so I had a personal interest in all the grim statitstics.  When I started dialysis, I had absolutely no complications from more than 30 years of diabetes, but by the end of those nine years, I had almost all the complications of the disease.  The cause of my kidney fairlure was not even diabetes, but was due to a rare auto-immune disease whose cause and cure are unknown, Wegener's Vasculitis.  Biopsies performed on my kidneys when I first started dialysis showed that I had suffered no damage at all from the diabetes after all those years.

During the time I was on dialysis, I saw three of my fellow diabetic dialysis patients -- one 28, one 36, and one 54 all die in less than the time I survived on dialysis.  The average life expectancy of a diabetic in his forties on dialysis is only 8 years.

[Sluff]

You can find all the data about the poor prognosis for diabetics on dialysis in Gabriel Danovitch's book, Handbook of Kidney Transplantation, Philadelphia: Lippincott, 2001, which I have often cited on this forum before.

Appreciate the name of your information source.

[stauffenberg]

When I first started dialysis i looked up the statistics and found that since I was a type 1 diabetic in my forties, and since patients in that category live on average only 8 years on dialysis, I had a 50% chance of surviving until a transplant, since in Canada the average waiting time for a kidney is 8 years.  Fortunately I escaped dialysis after 9 years, narrowly beating the odds, but I still suffered a lot of damage by cutting it that close.

[Danally]

When I first started dialysis i looked up the statistics and found that since I was a type 1 diabetic in my forties, and since patients in that category live on average only 8 years on dialysis, I had a 50% chance of surviving until a transplant, since in Canada the average waiting time for a kidney is 8 years.  Fortunately I escaped dialysis after 9 years, narrowly beating the odds, but I still suffered a lot of damage by cutting it that close.

How long ago did you get a transplant? What damage did you suffer. The information you received 9-years ago is outdated. I am sure they have made a lot of progress in the last 9-years.

[Bajanne]

How long ago did you get a transplant? What damage did you suffer. The information you received 9-years ago is outdated. I am sure they have made a lot of progress in the last 9-years.

I would definitely like to think so.  When my diabetic brother started dialysis in 1994, he started it in New York.  He was already legally blind from the disease.  He came back home with the news that if he didn't have dialysis 3 times a week, he could not make 5 years. At that time, our hospital only dialysed twice a week.   He went more than 5 years like that, and then they changed it to 3 times a week.  Even with all these challenges, my brother still lived 10 years, succumbing to a heart attack finally.
My kidney failure was not only due to my diabetes and hypertension, but also to some of the medication I was using for these ailments.  I was not being  properly monitored as I should have been.  I never had very severe diabetes, and I am hoping that I am able to be around for quite more than 8 years.
By the way, does the prognosis decrease or increase with age?  I started dialysis at 55 - is that better or worse than 40??

[Danally]

My dads diabetes was never really out of control either. I feel he was not properly monitored by his internist. He saw his internist every three months. He never told him his kidneys were failing. He found out when his ankle was swollen. Then they said his levels were high and he was having kidney failure.

[Sara]

All I know is that Joe's blood sugar has never been so well controlled since he started dialysis.  It's like the dialysis sucks all the extra blood sugar right out!  He is due for another hemoglobin A1C, so I guess we'll see after that, but as far as his self-tests at home, they're staying pretty steady and on target.  The one and only good thing so far.   

[stauffenberg]

Medicine is 99% politics and 1% science, and the fat salaries of the medical profession, as well as the huge profits of the pharmaceutical industry, private dialysis providers, private hospitals, and medical manufacturers, are all maintained by the constant propaganda, with which the headline-hungry media eagerly cooperates, that medicine is progressing at lightning speed.  In fact, however, as professional historians of medicines have recognized for decades now, medicine is stagnating, and the last major disease to be cured was polio more than half a century ago.  Most new medicines are minor alterations of existing drugs, developed only to circumvent patent protections. Survival rates for most diseases are not significantly improving, and the life expectacy of the average American male has actually been stagnant or declining in recent years.  During the 9 years I was on dialysis, I saw no progress at all in the treatment offered, and I saw little different in dialysis in 2005 than I had seen 20 years earlier when, as a student, I had written a study of dialysis centers in Germany.

The most recent medical study of the prognosis for diabetic renal patients -- by V. Sorensen, "Improved Survival Rate in Patients with Diabetes and Endstage Renal Failure in Denmark," Diabetologia, vol. 50 (May, 2007) 922-929, showed that instead of the average diabetic patient in his 40s dying after 8 years of renal failure, the survival had gone up to 9.2 years from 1990 to 2005 -- a very small amount, and that was in Denmark, where the standard of care for dialysis patients is much higher than in the rest of the world. This group result included transplant patients, who were the only diabetics with significant improvement in survival times, so the gain for non-transplant patients was trivial.

Paradoxically, another study by K. Kalantar-Zadah, "A1c and Survival in Maintenance Hemodialysis Patients" Diabetes Care, vol. 30 (May, 2007) 1049-1055, showed that the higher the A1c, thus the WORSE the blood sugar control, the longer the survival time on dialysis!  The authors believe that this cannot be cause and effect, and try to explain it away by various confounding variables, such as higher A1c correlating with better nutrition, etc.  But it does suggest that the A1c influence on survival is very small indeed.