Continuous Ambulatory Peritoneal Dialysis in Diabetics with End-Stage Renal Disease

Twenty diabetics with end-stage renal disease who had never previously received dialysis treatment were treated with continuous ambulatory peritoneal dialysis for periods of two to 36 months (average, 14.5). Intraperitoneal administration of insulin achieved good control of blood sugar. Even though creatinine clearance decreased significantly (P = 0.001), control of blood urea nitrogen and serum creatinine was adequate. Hemoglobin and serum albumin levels increased significantly (P = 0.005 and 0.04, respectively). Similarly, there was a significant increase in serum triglycerides and alkaline phosphatase (P = 0.02 and 0.05). Blood pressure became normal without medications in all but one of the patients. Retinopathy, neuropathy, and osteodystrophy remained unchanged. Peritonitis developed once in every 20.6 patient-months — a rate similar to that observed in nondiabetics. The calculated survival rate was 93 per cent at one year; the calculated rate of continuation on ambulatory peritoneal dialysis was 87 per cent. We conclude that continuous ambulatory dialysis with intraperitoneal administration of insulin is a good alternative treatment for diabetics with end-stage renal disease. (N Engl J Med. 1982; 306:625–30.) END-STAGE renal disease (ESRD) in diabetes continues to be a serious medical and socioeconomic problem. Good results have been obtained with transplantation of kidneys from identical, related donors, but the results of hemodialysis, intermittent peritoneal dialysis, or cadaveric transplantation in diabetics are not as good as those in nondiabetics. 1 Preliminary reports by Katirtzoglou 2 and Flynn 3 and their colleagues suggest that the plasma glucose levels of diabetics with ESRD may be restored to nearly normal by intraperitoneal administration of insulin during continuous ambulatory peritoneal dialysis. In addition, this type of dialysis provides excellent control of uremia and hypertension. These three features . . .