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Perit Dial Int 27(Supplement_2): 171-175
2007
© 2007 International Society for Peritoneal Dialysis
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Part 5: PD in Pediatric, Elderly, and Diabetic Patients

CAN WE OVERCOME THE PREDESTINED POOR SURVIVAL OF DIABETIC PATIENTS? PERSPECTIVES FROM PRE- AND POST-DIALYSIS

Yong-Lim Kim

Division of Nephrology and Department of Internal Medicine, Department of Biochemistry and Cell Biology, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence to: Y.L. Kim, Division of Nephrology and Department of Internal Medicine, Kyungpook National University Hospital, 50 Samduk-dong 2Ga, Jung-gu, Daegu 700-721 Korea. ylkim{at}knu.ac.kr

Although the survival of diabetic peritoneal dialysis (PD) patients has improved, it is still much worse than the survival of nondiabetic patients. Diabetes has its own risks for cardiovascular disease (CVD), such as increased levels of advanced glycation end-products, carbonyl and oxidative stress, and low-grade inflammation. An independent, graded association has been observed between a reduced glomerular filtration rate and the risk of CVD events in chronic kidney disease (CKD). Both CKD and diabetes synergistically lead to a high risk of CVD. It seems that the poor survival of diabetic PD patients is predestined at the initiation of dialysis because of multiple pre-existing risk factors and comorbid diseases, particularly CVD.

Recently, several trials were successful in improving the survival of patients with diabetic CKD. Tight control of glucose, blood pressure management using angiotensin converting-enzyme inhibitors or angiotensin II receptor blockers, and use of statins, antioxidants, or peroxisome proliferator-activated receptor gamma agonists may improve the survival of diabetic PD patients. However, simple correction of a single CVD risk factor is not likely to be effective. New PD solutions such as those low in glucose degradation products or those with icodextrin may also be effective in reducing the risk of CVD in diabetic PD patients. Therefore, multifactorial interventions—including diet control, early referral, and choice of an optimal PD solution—may improve the survival of diabetic PD patients.

KEY WORDS: Diabetes; survival; cardiovascular disease.






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