Specific aspects of peritoneal dialysis in diabetic patients

Together with hemodialysis and renal transplantation, peritoneal dialysis is an established method of renal replacement therapy. While evolving in parallel with hemodialysis worldwide, it was not until 1990 that peritoneal dialysis, as we know it today, was introduced to this country when high-quality disposables also became available. In the early 1990s, after adequately increasing the throughput of our dialysis and transplant centers, renal replacement therapy became available to all patients requiring it, that is, also to those with diabetes and other patients with comorbidities in this country. The mortality rates of dialysis-dependent patients with diabetes and chronic renal failure are significantly higher compared with those of dialysis patients without diabetes. This holds true both for hemodialysis and peritoneal dialysis. The survival rates of dialysis patients (with and without diabetes) over the first years of dialysis treatment are higher for those on peritoneal dialysis compared with hemodialysis, presumably because residual renal function is maintained longer with peritoneal dialysis. Peritoneal dialysis in patients with diabetes is usually associated with a higher incidence of peritonitis, but not its complications. This is not the case in our unit where the incidence of peritonitis does not differ significantly between patients with diabetes (1 : 38.9 months) and those without it (1 : 51.4 months). However, peritonitis incidence in our center is kept at levels much lower than accepted by the European guidelines (1 : 24) and those developed by the International Society of Peritoneal Dialysis (1 : 18), and than is usual in current clinical practice. Peritoneal dialysis patients and, in particular, those with diabetes, are likely to benefit from the use of modern peritoneal dialysis solutions containing the glucose polymer icodextrin or amino acids as the osmotic agent instead of glucose, or dialysis solutions with a reduced content of glucose degradation products. Such solutions have been shown to feature improved biocompatibility parameters and lower systemic metabolic load. Some observational non-randomized trials have reported improved survival and a lower incidence of peritonitis in patients both with and without diabetes treated with these modern dialysis solutions. Randomized trials are warranted to confirm these findings.

Keywords: chronic renal failure; peritoneal dialysis; diabetes mellitus; peritonitis