Dialysis in diabetic patients: hemodialysis and peritoneal dialysis. Pros and cons.

Both hemodialysis (HD) as well as peritoneal dialysis (PD), are efficient renal replacement therapies in uremic patients with and without diabetes. PD is less expensive dialysis modality and may provide a survival advantage over hemodialysis in first 2 to 4 years of treatment. Chronic ambulatory peritoneal dialysis (CAPD) as well as Continuous Cycler-Assisted Peritoneal Dialysis (CCPD) have additional advantages in patients with diabetes. PD therapy will be better tolerated than HD, the blood pressure is more stable and vascular access is not necessary. Preserving residual renal function (RRF) is of paramount importance to prolong the survival outcomes in PD patients. In insulin-dependent diabetic patients intraperitoneal insulin substitution can be used. The development of new, more biocompatible PD solutions holds promise for the future. Nevertheless, in many countries HD is further more favoured in the treatment of patients with ESRD.