Dialytic therapy for diabetic patients with terminal renal failure

Diabetes mellitus is the leading cause of irreversible renal failure in the United States, Japan, and industrialized Europe. Of those diabetic patients begun on uremia therapy, 80% are treated with hemodialysis and 12% with peritoneal dialysis. Continuous ambulatory peritoneal dialysis is proposed by some as appropriate primary therapy for many diabetics with end-stage renal disease (ESRD), but peritonitis is common at one episode per 11 to 21 patient-months. Cardiovascular disease is accelerated in patients with diabetic ESRD and is the most common cause of death in diabetic dialysis patients. Although survival of diabetic ESRD patients is lower than that of nondiabetic patients (1- and 5-year patient survival is 74% and 19%, respectively, in diabetics and 78% and 40%, respectively, in all ESRD patients), morbidity and mortality figures have improved steadily over the past two decades. When possible, renal transplantation is advised as the treatment most likely to effect rehabilitation and long survival.