Continuous Ambulatory Peritoneal Dialysis in Uremic Diabetics

  • Elias V. Balaskas
  • Dimitrios G. Oreopoulos


Diabetic nephropathy has become the leading cause of end-stage renal disease (ESRD) in such countries as United States, Japan, Scandinavia and much of Western Europe [1]. Haemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and renal transplantation are standard therapies for these patients. Despite encouraging results with renal transplantation [2], the majority are treated with dialysis, mainly because of the advanced age of most diabetics and the lack of kidney donors. When transplant is not available or is not medically feasible the choice of dialysis therapy depends on such factors as nephrologist bias, existence of extrarenal disease in the patient, treatment availability and other medical and social factors [1]. CAPD, which offers some advantages in the diabetic, was proposed, from early on, as the preferred dialytic treatment [3]. Now, CAPD is the first choice in dialytic treatment for ESRD in diabetes in Australia, New Zealand, England, Canada and some regions of the United States [1].


Peritoneal Dialysis Continuous Ambulatory Peritoneal Dialysis Residual Renal Function Continuous Ambulatory Peritoneal Dialysis Patient Peritonitis Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Markell MS, Friedman EA. Diabetic nephropathy: Management of the end-stage patient. Diabetes Care 1992; 15: 1226–1238.PubMedCrossRefGoogle Scholar
  2. 2.
    Passlick J, Grabensee B. CAPD and transplantation in diabetics. Clin Nephrol 1988; 30: suppl. 1: S18–S23.Google Scholar
  3. 3.
    Amair P, Khanna R, Leibel B, Pierratos A, Vas S, Meema E, Blair G, Chisolm L, Vas M, Zingg W, Digenis G, Oreopoulos DG. Continuous ambulatory peritoneal dialysis in diabetics with end-stage renal disease. N Engl J Med 1982; 306: 625–630.PubMedCrossRefGoogle Scholar
  4. 4.
    Khanna R. Dialysis considerations for diabetic patients. Kidney Int 1993; 43: suppl. 40: S58–S64.Google Scholar
  5. 5.
    Cardella CJ. Peritoneal dialysis and renal transplantation. Perit Dial Bull 1985; 5: 149–151.Google Scholar
  6. 6.
    Khanna R, Oreopoulos DG. Peritoneal access for chronic peritoneal dialysis. Int J Artif Organs 1985; 8: 1–6.PubMedGoogle Scholar
  7. 7.
    Khanna R, Macrier R. Oreopoulos D. Continuous ambulatory peritoneal dialysis in uremic diabetics. In: Mogensen CE (ed). The Kidney and Hypertension in Diabetes Mellitus (1st edition). Boston: Martinus Nijhoff Publishing; 1988; pp 331–339.Google Scholar
  8. 8.
    Hain H, Kessel M. Aspects of new solutions for peritoneal dialysis. Nephrol Dial Transplant 1987; 2: 67–72.PubMedGoogle Scholar
  9. 9.
    Scarpioni LL, Ballocchi S, Castelli A, Cecchettin M, Poisetti PG. Continuous ambulatory peritoneal dialysis in diabetic patients. Contrib Nephrol 1990; 84: 60–74.PubMedGoogle Scholar
  10. 10.
    Rottembourg J, Issad B, Allouache M, Baumelou A, Deray G, Jacobs C. Clinical aspects of continuous ambulatory and continuous cyclic peritoneal dialysis in diabetic patients. Perit Dial Int 1989; 9: 289–294.PubMedGoogle Scholar
  11. 11.
    Levey AS. Nephrology forum: measurement of renal function in chronic renal disease. Kidney Int 1990; 38: 167–184.PubMedCrossRefGoogle Scholar
  12. 12.
    Khanna R, Nolph KD, Oreopoulos DG. Peritoneal dialysis in diabetics. In: Khanna R, Nolph KD, Oreopoulos DG (eds). The Essentials of Peritoneal Dialysis. Dordrecht: Kluwer Academic Publishers; 1993; Chapter 10: pp 99–108.CrossRefGoogle Scholar
  13. 13.
    Tzamaloukas AH, Oreopoulos DG. Subcutaneous versus intraperitoneal insulin in the management of diabetics on CAPD: a review. Adv Perit Dial 1991; 7: 81–85.PubMedGoogle Scholar
  14. 14.
    Yuan ZY, Balaskas E, Gupta A, Bargman JM, Oreopoulos DG. Is CAPD or Haemo-dialysis better? CAPD is more advantageous. Semin Dialysis 1992; 5: 181–188.CrossRefGoogle Scholar
  15. 15.
    Rottembourg J. Peritoneal dialysis in diabetics. In: Dorlp KD (ed). Peritoneal Dialysis, 3rd ed. Dordrecht: Kluwer Academic Publishers; 1989; pp 365–379.CrossRefGoogle Scholar
  16. 16.
    Zingg W, Shirriff JM, Liebel B. Experimental routes of insulin administration. Perit Dial Bull 1982; 2: 24–27.Google Scholar
  17. 17.
    Duckworth WC. Insulin degradation: Mechanisms, products and significance. Endocrine Rev 1988; 9: 319–345.CrossRefGoogle Scholar
  18. 18.
    Rubin J, Bell AH, Andrews M, Jones Q, Olanch A. Intraperitoneal insulin: a dose response curve. ASAIO Trans 1989; 35: 17–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Rubin J, Reed V, Adair C, Bower J, Klein E. Effect of intraperitoneal insulin on solute kinetics in CAPD: Insulin kinetics in CAPD. Am J Med Sci 1986; 291: 81–87.PubMedCrossRefGoogle Scholar
  20. 20.
    Schade DS, Eaton RP. The peritoneum-A potential insulin delivery route for a mechanical pancreas (abstract). Diabetes Care 1980; 3: 229.PubMedCrossRefGoogle Scholar
  21. 21.
    Shapiro DJ, Blumenkrantz MJ, Levin SR, Coburn W. Absorption and action of insulin added to peritoneal dialysate in dogs. Nephron 1979; 23: 174–180.PubMedCrossRefGoogle Scholar
  22. 22.
    Wideroe T, Smeby LC, Berg KJ, Jorstad S, Svartas IM. Intraperitoneal insulin absorption during intermittent and continuous peritoneal dialysis. Kidney Int 1983; 23: 22–28.PubMedCrossRefGoogle Scholar
  23. 23.
    Madden MA, Zimmerman SW, Simpson DP. CAPD in diabetes mellitus: the risks and benefits of intraperitoneal insulin. Am J Nephrol 1982; 2: 133–139.PubMedCrossRefGoogle Scholar
  24. 24.
    Twardowski ZJ, Nolph KD, McGary TJ, Moore HL. Influence of temperature and time on insulin absorption to plastic bags. Am J Hosp Pharm 1983; 40: 583–586.PubMedGoogle Scholar
  25. 25.
    Saudek CD, Salem JL, Pitt HA, Waxman K, Rubio M, Jean Didier N, Turner D, Fischell RE, Charles MA. A preliminary trial of the programmable implantable medication system for insulin delivery. N Engl J Med 1989; 321: 574–579.PubMedCrossRefGoogle Scholar
  26. 26.
    Schmitz O. Insulin-mediated glucose uptake in nondialyzed and dialysed uremic insulin dependent diabetic subjects. Diabetes 1985; 34: 1152–1159.PubMedCrossRefGoogle Scholar
  27. 27.
    Grefberg N, Danielson BG, Nilson P, Berne C. Decreasing insulin requirements in CAPD patients given intraperitoneal insulin. J Diabetic Complications 1987; 1: 16–19.CrossRefGoogle Scholar
  28. 28.
    Selam JL, Kashyap M, Alberti KGMM, Lozano J, Hanna M, Turner D, Jean-Didier N, Chan Eve, Charles MA. Comparison of intraperitoneal and subcutaneous insulin administration on lipids apolipoproteins, fuel metabolites, and hormones in Type I diabetes mellitus. Metabolism 1989; 38: 908–912.PubMedCrossRefGoogle Scholar
  29. 29.
    Campbell PJ, Mandarino LJ, Gerich JE. Quantification of the relative impairment in actions of insulin on hepatic glucose production and peripheral glucose uptake in non-insulin dependent diabetes mellitus. Metabolism 1988; 37: 15–21.PubMedCrossRefGoogle Scholar
  30. 30.
    Duckworth WC, Saudek CD, Henry RR. Why intraperitoneal delivery of insulin with implantable pump in NIDDM? Diabetes 1992; 41: 657–661.PubMedCrossRefGoogle Scholar
  31. 31.
    Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Coronary heart disease risk and impaired glucose tolerance: The White Hall study. Lancet 1983; 1: 1373–1376.Google Scholar
  32. 32.
    Schade DS, Duckworth WC. In search of the subcutaneous insulin degradation syndrome. N Engl J Med 1986; 315: 147–153.PubMedCrossRefGoogle Scholar
  33. 33.
    Henderson IS, Patterson KR, Loung ACT. Decreased intraperitoneal insulin requirements during peritonitis on continuous ambulatory peritoneal dialysis. BMJ 1985; 290: 1474.PubMedCrossRefGoogle Scholar
  34. 34.
    Scalamogna A, Castelnova C, Crepaldi M, Guerra L, Graziani G, Captaluppi A, Ponticelli C. Incidence of peritonitis in diabetic patients on CAPD: Intraperitoneal vs. subcutaneous insulin therapy. In: Khanna R, Nolph KD, Prowant BF, Twardowski ZJ, Oreopoulos DG (eds). Advances in CAPD, volume 3. Toronto: University of Toronto Press; 1987; pp 166–170.Google Scholar
  35. 35.
    A Survey of diabetics in the CAPD/CCPD Population. In: Lindblad AS, Novak JW, Nolph KD, Stablein DM, Culter SJ, Steinberg SM, Vena DA (eds). Continuous Ambulatory Peritoneal Dialysis in the USA. Dordrecht: Kluwer Academic Publishers; 1989; pp 63–74.Google Scholar
  36. 36.
    Wanless IR, Bargman JM, Oreopoulos DG, Vas SL. Subcapsular steatonecrosis in response to peritoneal insulin delivery: A clue to the pathogenesis of steatonecrosis in obesity. Mod Pathol 1989; 2: 69–74.PubMedGoogle Scholar
  37. 37.
    Harrison NA, Rainford DJ. Intraperitoneal insulin and the malignant omentum syndrome (abstract). Nephrol Dial Transplant 1988; 3: 103.PubMedGoogle Scholar
  38. 38.
    Young MA, Nolph KD, Dutton S, Prowant BF. Anti-hypertensive drug requirements in continuous ambulatory peritoneal dialysis. Perit Dial Bull 1984; 4: 85–88.Google Scholar
  39. 39.
    Stablein DM, Hamburger RJ, Lindblad AS, Nolph KD, Noval JW. The effect of CAPD on hypertension control; a report of the National CAPD registry. Perit Dial Int 1988; 8: 141–144.Google Scholar
  40. 40.
    Rottembourg J, Issad B, Poignet JL, Stripoli P, Balducci A, Slama G, Gahl GM. Residual renal function and control of blood glucose levels in insulin-dependent diabetic patients treated by CAPD. In: Keen H, Legrain M (eds). Prevention and Treatment of Diabetic Nephropathy. Boston: Lancaster MTP Press Ltd; 1983; pp 339–359.Google Scholar
  41. 41.
    Rottembourg J, Issad B, Allouache M, Jacobs C. Recovery of renal function in patients treated by CAPD. In: Khanna R, Nolph KD, Prowant BF, Twardowski ZJ, Oreopoulos DG (eds). Advances in Peritoneal Dialysis, volume 5. Toronto: University of Toronto Press; 1989; pp 63–66.Google Scholar
  42. 42.
    Shekkarie MA, Port FK, Wolfe RA, Guire K, Humphrys R, Van Amburg G, Ferguson CW. Recovery from end-stage renal disease. Am J Kidney Dis 1990; 15: 61–65.Google Scholar
  43. 43.
    Herbelin A, Nguyen AT, Zingraft J, Urena P, Descamps-Latscha B. Influence of uremia and haemodialysis on circulating interleukin-1 and tumour necrosis factor alpha. Kidney Int 1990; 37: 116–125.PubMedCrossRefGoogle Scholar
  44. 44.
    Shah AH. Role of reactive oxygen metabolites in experimental glomerular disease. Kidney Int 1989; 35: 1093–1106.PubMedCrossRefGoogle Scholar
  45. 45.
    Rottembourg J, Remaoun M. Maiga K, Bellio P, Issad B, Boudjemaa A, Cossette PY. Continuous ambulatory peritoneal dialysis in diabetic patients. The relationship of hypertension to retinopathy and cardiovascular complications. Hypertension 1985; 7: suppl. 2: 125–130.Google Scholar
  46. 46.
    Tzamaloukas AH, Rogers K, Ferguson BJ, Leymon PC, Sena P, Merlin TL, Avasthi PS. Management of diabetics on CAPD with subcutaneous insulin. In: Khanna R, Nolph KD, Prowant B, Twardowski ZJ, Oreopoulos DG (eds). Advances in Continuous Ambulatory Peritoneal Dialysis, volume 4. Toronto: University of Toronto Press; 1988; pp 126–132.Google Scholar
  47. 47.
    Diaz-Buxo JA, Burgess WP, Greenman M, Chandler JT, Farmer CD, Walker PJ. Visual function in diabetic patients undergoing dialysis: comparison of peritoneal and haemodialysis. Int J Artif Organ 1984; 7: 257–262.Google Scholar
  48. 48.
    Kemperman FAW, van Leusen R, van Liebergen FJHM, Oosting J, Boeschoten EW, Struijk DG, Krediet RT, Arisz L. Continuous ambulatory peritoneal dialysis (CAPD) in patients with diabetic nephropathy. Neth J Med 1991; 38: 236–245.PubMedGoogle Scholar
  49. 49.
    Brown PM, Johnston KW, Fenton SA, Cattran DC. Symptomatic exacerbation of peripheral vascular disease with chronic ambulatory peritoneal dialysis. Clin Nephrol 1981; 16: 258–261.PubMedGoogle Scholar
  50. 50.
    Tzamaloukas AH, Murata GH, Harford AM, Sena P, Zager PG, Eisenberg B, Wood B, Simon D, Goldman RS, Kanig SP, Avasthi PS, Saddler MC. Hand gangrene in diabetic patients on chronic dialysis. ASAIO Trans 1991; 37: 638–643.PubMedGoogle Scholar
  51. 51.
    Khanna R, Wu G, Prowant B, Jastrzebska J, Nolph KD, Oreopoulos DG. Continuous ambulatory peritoneal dialysis in diabetics with end-stage renal disease: A combined experience of two North American centers. In: Friedman E, L’Esperance F (eds). Diabetic Renal-Retinal Syndrome 3. New York: Grune and Stratton; 1986; pp 363–381.Google Scholar
  52. 52.
    Coronel F, Tornero F, Macia M, Sanche A, De Oleo P, Naranjo P, Barrientos A. Peritoneal clearances, protein losses and ultrafiltration in diabetic patients after four years on CAPD. In: Khanna R, Nolph KD, Prowant B, Twardowski ZJ, Oreopoulos DG (eds). Advances in Peritoneal Dialysis, volume 7. Toronto: University of Toronto Press; 1991; pp 35–38.Google Scholar
  53. 53.
    Lee HB, Park MS, Chung SH, Lee YB, Kim KS, Hwang SD, Moon C. Peritoneal solute clearances in diabetics. Perit Dial Int 1990; 10: 85–88.PubMedGoogle Scholar
  54. 54.
    Lindblad AS, Novak JW, Nolph KD. Continuous Ambulatory Peritoneal Dialysis in the USA. Final report of the National CAPD registry 1981–1982. Dordrecht: Kluwer Academic Publishers; 1989; 30,37,258.CrossRefGoogle Scholar
  55. 55.
    Lindblad AS, Nolph KD, Novak JW, Friedman EA. A survey of the NIH CAPD Registry population with end-stage renal disease attributed to diabetic nephropathy. J Diabetic Complications 1988; 2: 227–232.CrossRefGoogle Scholar
  56. 56.
    Luzar MA, Coles GA, Faller B, Slingeneyer A, Dah GD, Briat C, Wone C, Knefati Y, Kessler M, Peluso F. Staphylococcus aureus carriage and infection in patients on continuous ambulatory peritoneal dialysis. N Engl J Med 1990; 322: 505–509.PubMedCrossRefGoogle Scholar
  57. 57.
    Holley JL, Bernandini J, Piraino B. Risk factors for tunnel infections in continuous peritoneal dialysis. Am J Kidney Dis 1991; 18: 344–348.PubMedGoogle Scholar
  58. 58.
    Tuazon CU. Staphylococcus aureus among insulin-injecting diabetic patients: An increased carried rate. JAMA 1975; 231–12721.Google Scholar
  59. 59.
    Krediet RT, Zuyderhoudt FMJ, Boeschoten EW, Arisz L. Peritoneal permeability to proteins in diabetic and non-diabetic continuous ambulatory peritoneal dialysis patients. Nephron 1986; 42: 133–140.PubMedCrossRefGoogle Scholar
  60. 60.
    Young CA, Kopple JD, Lindholm B, EF, DeVecchi A, Scalamogna A, Castelnova C, Oreopoulos DG, Anderson GH, Bergstrom J, et al. Nutritional assessment of continuous ambulatory peritoneal dialysis patients: an international study. Am J Kidney Dis 1991; 17: 462–471.PubMedGoogle Scholar
  61. 61.
    Marckmann P. Nutritional status of patients on haemodialysis and peritoneal dialysis. Clin Nephrol 1988; 29: 75–78.PubMedGoogle Scholar
  62. 62.
    Dombros NV, Digenis GE, Oreopoulos DG. Malnutrition in continuous ambulatory peritoneal dialysis and use of intraperitoneal amino acids. Int 1989; 35: 1189–1194.Google Scholar
  63. 63.
    Lameire N, Matthys D, Matthys E, Beheydt R. Effect of long-term CAPD on carbohydrate and lipid metabolism. Clin Nephrol 1988; 30: suppl. 1: S53-S58.Google Scholar
  64. 64.
    Appel G. Nephrology forum: Lipid abnormalities in renal disease. Kidney Int 1991; 39: 169–183.PubMedCrossRefGoogle Scholar
  65. 65.
    Burton PR, Walls J. A selection adjusted comparison of hospitalization on continuous ambulatory peritoneal dialysis and haemodialysis. J Clin Epidemiol 1989; 42: 531–539.PubMedCrossRefGoogle Scholar
  66. 66.
    Shapiro FL, Comty CM. Haemodialysis in diabetics — 1981 update. In: Friedman EA, L’Esperance FA (eds). Diabetic Renal-Retinal Syndrome. New York: Grune and Stratton; 1982; pp 309–320.Google Scholar
  67. 67.
    Catalano C, Goodship THJ, Tapson TS, Venning MK, Taylor RMR, Proud G, Tunbridge WM, Elliot RW, Ward MK, Alberti KGMM, Wilkinson R. Renal replacement therapy for diabetic patients in Newcastle-upon-Tyne and the northern region 1964–1988. BMJ 1990; 301; 535–540.PubMedCrossRefGoogle Scholar
  68. 68.
    Chandran PKG, Lane T, Flynn CT. Patient and technique survival for blind and sighted diabetics on continuous ambulatory peritoneal dialysis: a ten years analysis. Int J Artif Organs 1991; 14: 262–268.PubMedGoogle Scholar
  69. 69.
    Brunner FP. End-stage renal failure due to diabetic nephropathy: data from the EDTA registry. J Diabetic Complications 1989; 3: 127–135.CrossRefGoogle Scholar
  70. 70.
    U.S. Renal Data System. USRDS 1991 Annual Data Report. Bethesda: NIH; August 1991; D.38, D.40, E.56, E.57.Google Scholar
  71. 71.
    Zimmerman SV, Johnson CA, O’Brien M. Survival of diabetic patients on continuous ambulatory peritoneal dialysis for over five years. Perit Dial Bull 1987; 7: 26–29.Google Scholar
  72. 72.
    Balaskas EV, Yuan ZY, Gupta A, Meema HE, Blair G, Bargman J, Oreopoulos DG. Long-term continuous ambulatory peritoneal dialysis in diabetics. Clin Nephrology (in press).Google Scholar
  73. 73.
    Edelstein D, Brownlee M. Mechanistic studies of advanced glycosylation end product inhibition by aminoguanidines. Diabetes 1992; 41: 26–29.PubMedCrossRefGoogle Scholar
  74. 74.
    Yagihashi S, Kamijo M, Baba M, Yagihashi N, Najai K. Effect of aminoguanidine on functional and structural abnormalities in peripheral nerve of stz-induced diabetic rats. Diabetes 1992; 41: 47–52.PubMedCrossRefGoogle Scholar
  75. 75.
    Hamburger RJ, Mattern WD, Schreiber MJ, Doerblom R, Sorkin M, Zimmerman SW. A dialysis modality decision guide based on the experience of six dialysis centers. Dial Transplant 1990; 19: 66–69, 84.Google Scholar
  76. 76.
    Gokal R, Friedman EA, Rottembourg J, Tzamaloukas AH, Beeker GJ. Peritoneal dialysis in diabetic ESRD patients. Dial Transplant 1991; 20: 59–66, 88.Google Scholar
  77. 77.
    Wolfe RA, Port FK, Hawthorne VM, Guire KE. A comparison of survival among dialytic therapies of choise: in-center haemodialysis versus continuous ambulatory peritoneal dialysis at home. Am J Kidney Dis 1990; 15: 433–440.PubMedGoogle Scholar
  78. 78.
    Nelson CB, Port FK, Wolfe RA, Guire KE. Comparison of continuous ambulatory peritoneal dialysis and haemodialysis patient survival with evaluation of trends during the 1980s. J Am Soc Nephrol 1992; 3: 1147–1155.PubMedGoogle Scholar
  79. 79.
    Nelson CB, Port FK, Wolfe RA, Guire KE. Dialysis patient survival: Evaluation of CAPD vs HD using 3 techniques (abstract). Perit Dial Int 1992; 12: suppl. 1: 144.Google Scholar
  80. 80.
    Abraham G, Zlotnik N, Ayiomamitis A, Oreopoulos DG. Drop-out of diabetic patients from CAPD. In: Khanna R, Nolph KD, Prowant B, Twardowski ZJ, Oreopoulos DG (eds). Advances in Continuous Ambulatory Peritoneal Dialysis, volume 3. Toronto: University of Toronto Press; 1987; pp 199–204.Google Scholar
  81. 81.
    Rubin J, Hsu H. Continuous ambulatory peritoneal dialysis: ten years at one facility. Am J Kidney Dis 1991; 17: 165–169.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Elias V. Balaskas
  • Dimitrios G. Oreopoulos

There are no affiliations available

Personalised recommendations