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Peritoneal dialysis in diabetic end-stage renal disease

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Textbook of Peritoneal Dialysis

Abstract

The management of diabetic patients with end-stage renal disease (ESRD) has undergone significant changes over the past 20 years. In countries with adequate socioeconomic conditions, even diabetics with extensive comorbid diseases refused renal transplantation are generally accepted for chronic dialysis despite the inevitably poor long-term prognosis [1–4]. As a result, diabetes has become the most prevalent cause of ESRD in the USA; on average about one-third of new dialysis patients have diabetes as the cause of renal disease [5]. Renal transplantation is the generally preferred treatment for diabetic patients with end-stage renal failure because it leads to better quality of life than any form of dialysis [6]. Though the first year mortality in diabetic patients on dialysis (haemodialysis or peritoneal dialysis) has decreased dramatically between 1985 and 1995, diabetic renal disease still has one of the highest mortality rates at the end of first year of dialysis when compared to renal transplantation and dialysis in non-diabetics [7]. Nearly half of the diabetic patients begun on dialysis do not survive beyond 2 years, and less than one in five diabetic patients undergoing maintenance dialysis is capable of any activity beyond personal care [8]. In such a setting, choosing a dialytic mode which has a better potential for survival, and that promotes better quality of life, is extremely important. However, choosing a dialysis therapy at present is subject to the strong personal biases of both physician and patient. This is because a clear difference between the outcomes of haemodialysis and peritoneal dialysis for diabetic patients has not been observed. In the 1960s and early 1970s intermittent peritoneal dialysis (IPD) performed on diabetic ESRD patients, either in hospital or at home, with a cycler over 30–40 h/week, showed a promising decline or even arrest of uraemic neuropathy and retinopathy. However, possibilities for patient survival beyond 2–3 years were dismal [9–13]. Thus, it appears that with the loss of residual-renal function, which takes about 2–3 years in PD patients, the amount of dialysis provided with IPD was not adequate, and the majority of patients were dying from either electrolytic abnormalities or progressive uraemia. The introduction of continuous ambulatory and continuous cyclic peritoneal dialysis (CAPD/CCPD) during the late 1970s allowed both diabetic and non-diabetic patients to be treated adequately, and was quickly established as a viable alternative renal replacement therapy to haemodialysis [14–22].

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Authors
  1. M. Misra
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  2. R. Khanna
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Editor information

Editors and Affiliations

  1. Department of Renal Medicine, Manchester Royal Infirmary, Oxford Road, M13 9WL, Manchester, UK

    R. Gokal

  2. Division of Nephrology, Department of Medicine, MA 436 Health Services Centre, University of Missouri-Columbia, 65212, Columbia, MO, USA

    R. Khanna

  3. Academisch Medisch Centrum, Amsterdam, The Netherlands

    R. Th. Krediet

  4. Department of Internal Medicine, MA 436 Health Sciences Center, University of Missouri-Columbia, 65212, Columbia, MO, USA

    K. D. Nolph

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Misra, M., Khanna, R. (2000). Peritoneal dialysis in diabetic end-stage renal disease. In: Gokal, R., Khanna, R., Krediet, R.T., Nolph, K.D. (eds) Textbook of Peritoneal Dialysis. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-3225-3_21

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