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

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 assessment 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 deterioration of visual acuity resulted from either hypertension 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.