Purpose Type 1 diabetes mellitus commonly leads to the development of diabetic autonomic neuropathy (DAN) in patients manifesting complications of microangiopathy such as diabetic neuropathy. Orthostatic hypotension (OH) as a result of DAN can often be disabling and require specific medical therapy such as ProAmatine. Likewise, intradialytic hypotension is common in end-stage renal disease (ESRD) patients with DAN and often limits efforts at ultrafiltration. Features of DAN were followed in patients undergoing successful simultaneous kidney and pancreas transplantation (SPK).
Method Sixty-nine patients undergoing SPK between 2/01 and 4/04 and followed at LHI maintained insulin independence and stable renal allograft function. All but one patient with a bladder-drained pancreas underwent portoenteric pancreas drainage. Blood pressure, weight, number of antihypertensive medications, and need for pharmacologic therapy for OH were measured before and after SPK. Pretransplant renal replacement consisted of hemodialysis (HD) for 52 patients, peritoneal dialysis (PD) for 21 patients and initially HD and then PD for 14 patients. Subjective symptoms referable to retinopathy, peripheral neuropathy, hypotension, and gastroparesis were also monitored.
Results The number of antihypertensive agents was reduced from mean 5.4 to mean 1 after SPK (p < .001). More patients (17.4%) required the use of ProAmatine after SPK than while on dialysis (0%) (p < .001). Body weight decreased by average of 5.85 kg immediately after SPK (p < .001). Patient subjective symptoms of dizziness (p < .001), diarrhea (p < .001), and peripheral neuropathy (p < .02) improved but gastroparesis (p = .06) and retinopathy (p = .628) remained unchanged.
Conclusions Because of DAN, most type 1 diabetic patients with ESRD are unable to achieve a true dry body weight and remain volume overloaded. This results in the use of antihypertensive agents. Following successful SPK, weight immediately drops as a result of the correction in volume overload by a normally functioning kidney and translates into a reduction in the number of antihypertensive agents and increase in the use of pressor agents such as ProAmatine.