The Textbook of Peritoneal Dialysis

pp 639-659

Peritoneal dialysis in diabetic end-stage renal disease

  • Ramesh Khanna

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The management of the diabetic patients with end-stage renal disease (ESRD) has undergone significant change over the past 20 years. In countries with adequate socioeconomic conditions, even diabetics with extensive comorbid diseases denied renal transplantation easily get accepted for chronic dialysis despite the inevitable poor long-term prognosis [1–4]. As a result, diabetes has become the most prevalent cause of ESRD in the USA; on average, about one-third of the new dialysis patients have diabetes as the cause of renal disease [5]. 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 [6]. Although improved compared to a decade ago, the outcome of dialysis therapies (hemodialysis or peritoneal dialysis) for diabetics is still disappointing compared to renal transplantation and dialysis for non-diabetics; nearly half the diabetic patients, who begin dialysis do not survive beyond two years [7] and less than one in five diabetic patients undergoing maintenance dialysis is capable of any activity beyond personal care.