OPTIMAL USE OF PERITONEAL DIALYSIS IN PATIENTS WITH DIABETES

Kidney Center, 1 Soon Chun Hyang University Hospital; Hyonam Kidney Laboratory, 2 Soon Chun Hyang University; Ewha Womans University College of Pharmacy, 3 Seoul; and Kim's Clinic and Dialysis Unit, 4 Miryang, Korea Correspondence to: H.B. Lee, Soon Chun Hyang University College of Medicine, Kim's Clinic and Dialysis Unit, 721-4 Naeedong, Miryang 627-803 Korea. bahllee{at}naver.com The survival of patients with end-stage renal disease (ESRD) resulting from diabetes continues to improve, but the survival rate among diabetic ESRD patients remains the lowest among all primary diagnoses probably because of the higher prevalence of cardiovascular comorbidity associated with diabetes. Diabetes, age, and comorbidity all significantly modify the effect of treatment modality on patient survival. As compared with hemodialysis (HD), peritoneal dialysis (PD) offers an equal or lower risk of death across all subgroups during the first 1–2 years of dialysis. The association of PD with better outcomes than are seen with HD is probably a result of a lower prevalence of infections and congestive heart failure and better preservation of residual renal function (RRF) in PD patients. Use of angiotensin converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) helps to preserve RRF in ESRD patients and to maintain peritoneal membrane integrity longer in PD patients. Antioxidants can also support preservation of peritoneal membrane function. Peritoneal dialysis should be the initial modality of dialysis in all ESRD patients. Older patients (age 45 years) with diabetes and patients without diabetes may switch to HD or receive a kidney graft in 1–2 years' time; younger patients (age < 45 years) with diabetes may stay on PD longer. Use of ACEI and ARB or antioxidants can help to maintain peritoneal membrane function longer. KEY WORDS: Congestive heart failure; diabetes mellitus; end-stage renal disease; infection; peritoneal membrane; residual renal function.