Peritoneal dialysis in diabetic end-stage renal disease

There has been a progressive improvement in the survival of diabetics with end-stage renal disease on peritoneal dialysis. Since its introduction in 1976, large numbers of diabetics have been preferentially treated by continuous ambulatory peritoneal dialysis (CAPD). CAPD offers the potential advantage of reduced cardiovascular stress, a steady biochemical state, good control of hypertension and extracellular fluid volume, and intraperitoneal administration of insulin. In addition, peritoneal access is easy to establish, CAPD offers freedom from a machine, and enables travel without upsetting facility dialysis schedules. The effects of intraperitoneal insulin are almost similar to normal insulin secretion. Although limited, the long-term experiences of CAPD in diabetics tend to show lower technique and survival results compared to nondiabetics. The incidence of peritonitis is no different between the diabetics and nondiabetics on CAPD. Continuous clyclic peritoneal dialysis is indicated in those who prefer nightly dialysis or those who are unable to do exchanges during daytime. Intermittent peritoneal dialysis is the least preferred therapy because of its inability to provide adequate dialysis.