Peritoneal dialysis in diabetic patients

Diabetes mellitus is the fastest growing cause of end-stage renal disease ( ESRD) and has become the leading cause of such ESRD worldwide. In the Unite d States, between 1984 and 1997, the proportion of new patients starting re nal replacement therapies whose ESRD was caused by diabetes increased from 27% to 44.4%. Canada sew an increase from 16.5% in 1984 to 28.9% in 1997, a nd many European countries had similar increases. Among the modes of renal replacement, many clinicians have favored continuous ambulatory peritoneal dialysis (CAPD) for the treatment of diabetic ESRD for several reasons. Man y studies have compared clinical outcomes in diabetic patients undergoing C APD. and nondiabetic patients undergoing CAPD, or diabetic patients undergo ing peritoneal dialysis (PD) and those undergoing hemodialysis (HD). Howeve r, only a small number of diabetic dialysis patients have been followed up for more than 5 years, largely because of the presence of several comorbid conditions at the start of dialysis and the coexistence of far-advanced tar get-organ damage at dialysis initiation and its progression during the cour se of dialysis. Diabetic patients undergoing PD and HD probably have simila r survival, and those undergoing CAPD have lower survival and technique suc cess rates than nondiabetic patients of comparable age. This article review s the literature and our experience with diabetic patients undergoing PD an d compares clinical outcomes in diabetic patients undergoing PD and HD. (C) 2001 by the National Kidney Foundation, Inc.