Peritoneal Dialysis in Diabetics: There Is Room for More

Abstract

End stage renal disease diabetic patients suffer from worse clinical outcomes under dialysis-independently of modality. Peritoneal dialysis offers them the advantages of home therapy while sparing their frail vascular capital and preserving residual renal function. Other benefits and potential risks deserve discussion. Predialysis intervention with early nephrology referral, patient education, and multidisciplinary support are recommended. Skilled and updated peritoneal dialysis protocols must be prescribed to assure better survival. Optimized volume control, glucose-sparing peritoneal dialysis regimens, and elective use of icodextrin are key therapy strategies. Nutritional evaluation and support, preferential use of low-glucose degradation products solutions, and prescription of renin-angiotensin-aldosterone system acting drugs should also be part of the panel to improve diabetic care under peritoneal dialysis.

Outcome of patients with hemodialysis or peritoneal dialysis undergoing simultaneous pancreas‐kidney transplantation. Comparative study

“…A series of more than 400 patients showed that survival rate of diabetics on PD was equal to that of non‐diabetics on HD, and diabetics on HD had the worst survival . It has been suggested that new PD solutions with low accumulation of glucose degradation products may reduce the risk of cardiovascular disease in diabetic patients, by preserving residual renal function, optimizing volume control, and possibly reducing local and systemic inflammation …”

“…20,21 Several potential risks of PD in diabetic patients have been described (fluid overload, dysregulation of metabolic response to glucose, hyperinsulinemia, obesity, dyslipidemia, and peritoneal infection), but important benefits have also been reported (homebased continuous therapy, more liberal diet, intraperitoneal insulin administration, better preservation of residual renal function and blood pressure control, preservation of vascular access, avoidance of myocardial stunning and circulatory stress, and no need for systemic anticoagulation). 22 A series of more than 400 patients showed that survival rate of diabetics on PD was equal to that of nondiabetics on HD, and diabetics on HD had the worst survival. 23 It has been suggested that new PD solutions with low accumulation of glucose degradation products may reduce the risk of cardiovascular disease in diabetic patients, by preserving residual renal function, optimizing volume control, and possibly reducing local and systemic inflammation.…”

“…23 It has been suggested that new PD solutions with low accumulation of glucose degradation products may reduce the risk of cardiovascular disease in diabetic patients, by preserving residual renal function, optimizing volume control, and possibly reducing local and systemic inflammation. 22 Series comparing PD and HD prior to SPKT have also shown discordant results with respect to patient and pancreas graft survival and the rate of post-transplant intra-abdominal infections. [6][7][8][9][10][11][12][13] Our present series of SPKTs shows homogeneity with respect to the distribution of donor, recipient, and perioperative variables between the groups, and intra-abdominal infections, thrombosis, 27 and are associated with higher risk of mortality and pancreas graft loss.…”

Factors Associated with Above and Under 5-Year Survival in Peritoneal Dialysis Patients

“…It is likely due to the high prevalence of CVD and metabolic complications in this population. 19,20 In our study, diabetes was the most common cause of ESRD. Despite the high rate of detection of DM in patients living less than 5 years, it did not affect patient survival significantly.…”

Peritoneal dialysis – risk factor for glycemic variability assessed by continuous glucose monitoring system

“…Several studies indicated that in PD patients insulin resistance and glucose overload may represent important factors that significantly influence glycemic variability [7]. The glucose excursions are exacerbated and difficult to assess due to the influence of both the uremic status and PD per se [8].…”