Peritoneal Dialysis in Diabetic End-Stage Renal Disease

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The management of diabetic patients with end-stage renal disease (ESRD) has undergone significant changes over the past few decades. Diabetics with extensive co-morbid diseases 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 United States. Between 1984 and 1997, the percentage of new patients starting renal replacement therapy (RRT) with ESRD due to diabetes increased from 27% to 42.9% in United States [5]. The 1- and 2-year mortality for diabetic patients in peritoneal dialysis (PD) between the years 1989 and 1998 has decreased by 26.6 and 20% per 1,000 patient years, respectively [5]. However, 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 nondiabetics [6]. Diabetic patients, regardless of dialysis modality, continue to have the lowest 5 year survival [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]. 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 [9].