Clinical Aspects of Continuous Ambulatory and Continuous Cyclic Peritoneal Dialysis in Diabetic Patients

Abstract

The treatment of end-stage renal diabetic nephropathy, remains a challenge. A large experience allows us to clearly outline the advantages and the drawbacks of continuous ambulatory peritoneal dialysis (CAPO) and continuous cyclic peritoneal dialysis (CCPO). Eighty-one patients, mean age 51.3 years, were treated over the last 9 years by CAPO-CCPO. Extrarenal complications, mainly vascular lesions, were present in this high-risk group of patients. The technique was modified in order to inject intraperitoneally, 4 times per day, insulin to control blood glucose level in CAPO patients. Actuarial survival was 92% at 1 year, 50% at 4 years mainly influenced by age: 85% survival at 2 years in 35 patients aged less than 50 years old and 62% at 2 years in 46 patients aged more than 50 years old. The main causes of death were of cardiovascular origin: myocardial infarction, stroke, atherosclerotic vasculopathy. The main causes of transfer to hemodialysis were due to technical complications. Peritonitis rate was one episode every 14 patientmonths. Control of blood pressure, blood glucose levels, main biological parameters, and visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPO-CCPO is the technique of first choice in young diabetics and the preferential technique for home dialysis.

A Comparison of Outcomes between Diabetic and Nondiabetic Capd Patients in India

“…Identical probability and technique failure due to peritonitis in the two groups have also been observed in other studies (3). The peritonitis rate in our cohort of CAPD patients appears to be comparable to reports of peritonitis rates in recent literature (30,31) and is better than our previous peritonitis rate (32). The improved peritonitis rate may be due to the use of disconnect systems in all patients from the start of CAPD.…”

When is it time to start dialysis?

“…There would be a needless early imposition of lifestyle restrictions and increased costs. There is an additional concern of possibly hastening the decline in residual renal function (26), arising from the observation that hemodialysis patients have a more rapid decline in renal function than those on peritoneal dialysis (27)(28)(29). Such studies, however, have yielded contradictory results.…”