Long-term survival on peritoneal dialysis in end-stage renal disease owing to diabetes.

Only a small number of peritoneal dialysis (PD) patients with diabetes have been followed for more than 5 years. Lack of extended follow-up for these patients is largely due to coexisting, far-advanced damage to target organs at initiation of dialysis, with progression of that damage during the course of dialysis; the presence of various comorbid conditions at the start of dialysis; and limits to long-term PD technique. Among renal replacement modalities, continuous ambulatory peritoneal dialysis (CAPD) has been favored by many clinicians for the treatment of diabetic patients owing to reasons inherent in the therapy. Reported survival rates of diabetic patients on CAPD vary from 17%-72% for the fourth year (mean value: 39%) and from 19%-63% for the fifth year (mean value: 35%). Diabetic patients have actuarial rates of patient survival and technique survival that are lower than those for non diabetic patients of comparable age on CAPD. Patient survival for diabetic patients undergoing PD is similar to that for diabetic patients on hemodialysis. Because the peritoneal membrane maintains its ability to adequately purify blood for a long time, CAPD remains a viable form of long-term renal replacement therapy for diabetic patients with end-stage renal disease.