Search

Hypertension is highly prevalent in both types I (87%) and type II (95) uremic diabetics at the time of kidney transplantation. Hypertension was diagnosed a mean of 16.9 yrs in type I, and 2.9 yrs in type II diabetics after the clinical diagnosis of diabetes was made. The majority (81%) of our patients were hypertensive postkidney transplant. Only 13% of hypertensive recipients became normotensive post-transplant. This group had a lower mortality rate (1/8, 12.5%), and all survivors (100%) had good graft function (mean creatinine = 1.6 +/- 0.6, range 0.9 to 2.5 mg/dl). By contrast, recipients who remained hypertensive post-transplantation had a much higher mortality rate (25/54, 48%), and loss of graft function necessitating dialysis occurred frequently (19/54, 35%). Of hypertensive diabetic recipients alive at a mean of 21 mos post-transplant, renal function was worse (mean creatinine = 3.1 +/- 3.0, range 1.0 to 13.7 mg/dl) than in nonhypertensive recipients. We conclude that while renal transplantation may be the treatment of choice in patients with diabetes mellitus, failure to control hypertension negatively biases the ultimate post-transplant course.

BTG levels are significantly elevated in patients on chronic hemodialysis. The increased levels are not due to turbulent flow within the vascular access, but may be due to platelet aggregation within the hemodialyzer during the first hour of dialysis. This effect is observed with the Travenol CF series hollow fiber (cuprophane) but not the Cordis-dow artificial kidney (regenerated cellulose).

Our study indicates that in renal failure elevated plasma triglyceride can first be detected when the GFR falls to 50 ml/min. Hypertriglyceridemia is the commonest abnormality found and increases further when the GFR falls below 10 ml/min. Plasma cholesterol levels remain normal even at low levels of renal function. Although plasma growth hormone, glucagon, and insulin levels become elevated when renal function diminishes, there is no definite correlation of their levels and GFR. A decreased incidence of hyperlipidemia observed in patients sustained by maintenance hemodialysis for over 5 yrs may in part be due to the triglyceride lowering effect of growth hormone and glucagon and/or the cholesterol lowering effect of insulin.