Improving the care of diabetic patients on peritoneal dialysis

An overwhelming majority of patients on dialysis reach end-stage renal disease (ESRD) secondary to diabetes mellitus (DM). Although renal transplantation offers the best option for these patients, shortage of available kidneys becomes a major impediment. Besides hemodialysis (HD), peritoneal dialysis (PD) is also a commonly offered dialysis modality to these patients. However, PD in diabetics poses unique challenges. A constant exposure to glucose in the dialysate may further worsen the internal milieu of hyperglycemic diabetic individuals. A number of factors may help improve outcomes in such patients. Protection of the peritoneal membrane and residual renal function (RRF) are extremely important in this regard. Close monitoring of blood glucose levels and prompt management of peritoneal and exit site infections can prevent long term complications. This brief review addresses some important measures that can help improve outcomes of such patients on PD.