Peritoneal dialysis. More autonomy for chronic dialysis patients with diabetes

Peritoneal dialysis (PD) is a modern kidney replacement option capable of meeting the high demands placed on the desired quality of life in a home therapy setting. Survival probability is comparable between hemodialysis (HD) and PD and some retrospective analyses have even proven lower mortality in the first years of PD. Especially diabetics benefit from PD as the initial dialysis treatment because it offers a better quality of life, better preservation of residual renal function, less electrolyte disorders, no complications due to fistulas for HD and less hypotensive periods. Higher peritoneal glucose absorption needs to be treated with equivalent insulin therapy according to the specific regimen to achieve adequate blood sugar control. It is recommended to treat diabetics with a stable PD regimen and especially in case of diabetes patients may benefit from modern glucose-free PD solutions. Oral antidiabetics play a minor role due to renal elimination and the risk of hyoglycemia. Standard therapy for diabetics is subcutaneous insulin rather than intraperitoneal administration.