Specific aspects of peritoneal dialysis in diabetic patients

Czech version

Authors: S. Opatrná; J. Klaboch
Authors‘ workplace: I. interní klinika Lékařské fakulty UK a FN Plzeň, přednosta doc. MUDr. Martin Matějovič, Ph. D.
Published in: Vnitř Lék 2008; 54(5): 523-529
Category:

Předneseno na 9. celostátním diabetologickém sympoziu „Diabetes a urogenitální systém“ ve dnech 1.-2. června 2007 v Novém Adalbertinu v Hradci Králové

Overview

Together with hemodialysis and renal transplantation, peritoneal dialysis is an established method of renal replacement therapy. While evolving in parallel with hemodialysis worldwide, it was not until 1990 that peritoneal dialysis, as we know it today, was introduced to this country when high-quality disposables also became available. In the early 1990s, after adequately increasing the throughput of our dialysis and transplant centers, renal replacement therapy became available to all patients requiring it, that is, also to those with diabetes and other patients with comorbidities in this country. The mortality rates of dialysis-dependent patients with diabetes and chronic renal failure are significantly higher compared with those of dialysis patients without diabetes. This holds true both for hemodialysis and peritoneal dialysis. The survival rates of dialysis patients (with and without diabetes) over the first years of dialysis treatment are higher for those on peritoneal dialysis compared with hemodialysis, presumably because residual renal function is maintained longer with peritoneal dialysis. Peritoneal dialysis in patients with diabetes is usually associated with a higher incidence of peritonitis, but not its complications. This is not the case in our unit where the incidence of peritonitis does not differ significantly between patients with diabetes (1 : 38.9 months) and those without it (1 : 51.4 months). However, peritonitis incidence in our center is kept at levels much lower than accepted by the European guidelines (1 : 24) and those developed by the International Society of Peritoneal Dialysis (1 : 18), and than is usual in current clinical practice. Peritoneal dialysis patients and, in particular, those with diabetes, are likely to benefit from the use of modern peritoneal dialysis solutions containing the glucose polymer icodextrin or amino acids as the osmotic agent instead of glucose, or dialysis solutions with a reduced content of glucose degradation products. Such solutions have been shown to feature improved biocompatibility parameters and lower systemic metabolic load. Some observational non-randomized trials have reported improved survival and a lower incidence of peritonitis in patients both with and without diabetes treated with these modern dialysis solutions. Randomized trials are warranted to confirm these findings.

Key words:
chronic renal failure - peritoneal dialysis - diabetes mellitus - peritonitis

Sources

1. Ahmad S, Sehmi JS, Ahmad-Zakhi KH et al. Impact of new dialysis solutions on peritonitis rates. Kidney Int 2006; 70: S63-S66.

2. Chou MY, Kao MT, Lai MN et al. Comparisons of the peritoneal equilibration test and ultrafiltration in patients with and without diabetes mellitus on continuous ambulatory peritoneal dialysis. Am J Nephrol 2006; 26: 87-90.

3. Chow KM, Szeto CC, Leung CB et al. A risk analysis of continuous ambulatory peritoneal dialysis-related peritonitis. Perit Dial Int 2005; 25: 374-379.

4. Chung SH, Chu WS, Lee HA et al. Peritoneal transport characteristics, comorbid diseases and survival in CAPD patients. Perit Dial Int 2000; 20: 541-547.

5. Churchill DN, Taylor DW, Keshaviah PR (for the CANUSA Peritoneal Dialysis Study Group). Adequacy of dialysis and nutrition in continuous peritoneal dialysis. Association with clinical outcomes. J Am Soc Nephrol 1996; 7: 198-207.

6. Collins AJ, Hao W, Xia H et al. Mortality risks of peritoneal dialysis and hemodialysis. Am J Kidney Dis 1999; 34: 1065-1074.

7. Dombros N, Dratwa M, Feriani M et al. EBPG Expert Group on Peritoneal Dialysis. European best practice guidelines for peritoneal dialysis. 3 Peritoneal access. Nephrol Dial Transplant 2005; 20(Suppl 9): ix8-ix12.

8. Fried L, Piraino B. Peritonitis. In: Gokal R, Khanna R, Krediet RT (Eds). Textbook of Peritoneal Dialysis. Dordrecht, Boston, London: Kluwer Academic Publishers 2000: 545-564.

9. Ganesh SK, Julber-Shearon T, Port FK et al. Mortality differences by dialysis modality among incident ESRD patients with and without coronary artery disease. J Am Soc Nephrol 2003; 14: 415-424.

10. Gillerot G, Goffin E, Michel C et al. Genetic and clinical factors influence the baseline permeability of the peritoneal membrane. Kidney Int 2005; 67: 2477-2487.

11. Grassmann A, Gioberge S, Moeller S et al. ESRD patients in 2004: Global overview of patient numbers, treatment modalities and associated trends. Nephrol Dial Tranplant 2005; 20: 2578-2593.

12. Hájková B, Fixa P. Současné trendy v léčbě peritonitid u nemocných léčených peritoneální dialýzou. Vnitř Lék 2004; 50: 619-623.

13. Heaf JG, Lokkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant 2002; 17: 112-117.

14. Jaar BG, Coresh J, Plantinga LC et al. Comparing the risk of death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. Ann Intern med 2005; 143: 174-183.

15. Konings CJ, Kooman JP, Schonck M et al. Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: a randomized study. Kidney Int 2003; 63: 1556-1563.

16. Kopple JD, Bernard D, Messana J et al. Treatment of malnourished CAPD patients with an amino acid based dialysate. Kidney Int 1995; 47: 1148-1157.

17. Krediet RT. Peritoneal Solute Transport and Ultrafiltration. In: Gokal R, Khanna R, Krediet RT (Eds). Textbook of Peritoneal Dialysis. Dordrecht, Boston, London: Kluwer Academic Publishers 2000: 135-172

18. Lee HY, Choi HY, Park HC et al. Changing prescribing practice in CAPD patients in Korea: increased utilization of low GDP solutions improves patient outcome. Nephrol Dial Transplant 2006; 21: 2893-2899.

19. Liem YS, Wong JB, Hunink MGM et al. Comparison of hemodialysis and peritoneal dialysis survival in The Netherlands. Kidney Int 2007; 71: 153-158.

20. Marshall J, Jennings P, Scott A et al. Glycemic control in diabetic CAPD patients assessed by continuous glucose monitoring system (CGMS). Kidney Int 2003; 64: 1480-1486.

21. Mehrotra R. Peritoneal dialysis penetration in the United States: march toward the fringes? Perit Dial Int 2006; 26: 419-422.

22. Mistry CD, Gokal R, Peers EM. A randomized multicenter clinical trial comparing isosmolar icodextrin with hyperosmolar glucose solutions in CAPD. MIDAS Study Group. Multicenter investigation of icodextrin in ambulatory peritoneal dialysis. Kidney Int 1994; 46: 496-503.

23. Montenegro J, Saracho R, Gallardo I et al. Use of pure bicarbonate-buffered peritoneal dialysis fluid reduces the incidence of CAPD peritonitis. Nephrol Dial Transplant 2007; 22: 1703-1708.

24. Mujais S. Microbiology and outcomes of peritonitis in North America. Kidney Int 2006; 70(Supl 103): 55-62.

25. Murphy SW, Foley RN, Barrett BJ et al. Comparative mortality of hemodialysis and peritoneal dialysis in Canada. Kidney Int 2000; 57: 1720-1726.

26. Nissenson AR, Prichard SS, Cheng IK et al. ESRD modality selection into the 21st century: the importance of non medical factors. ASAIO J 1997; 43: 143-150.

27. Oo TN, Roberts TL, Collins AJ. A comparison of peritonitis rates from the United States Renal Data System database: CAPD versus continuous cycling peritoneal dialysis patients. Am J Kidney Dis 2005; 45: 372-380.

28. Opatrná S, Šefrna F. Development of peritoneal dialysis and renal replacement therapy in the Czech Republic since the postcomunist transition. Perit Dial Int 2007; 27: 196-202.

29. Opatrná S. Lze dále snižovat výskyt peritonitidy sdružené s peritoneální dialýzou? Vnitř Lék 2004; 50: 578-581.

30. Opatrná S, Racek J, Stehlik P et al. Vliv podání dialyzačního roztoku s icodextrinem na ultrafiltraci a vybrané metabolické parametry nemocných léčených peritoneální dialýzou. Čas Lék Čes 2002; 141: 281-285.

31. Opatrná S, Liška J, Vít L et al. Vliv dialyzačního roztoku s obsahem aminokyselin na nutriční stav nemocných léčených kontinuální ambulantní peritoneální dialýzou (CAPD). Čas Lék Čes 1997; 136: 409-412.

32. Opatrný K jr. Zamyšlení nad současným stavem chronické dialýzy v České republice. Akt Nefrol 1995; 2: 11-14.

33. Piraino B, Bailie GR, Bernardini J et al. ISPD Guidelines/Recommendations. Peritoneal dialysis-related infections Recommendations: 2005 Update. Per Dial Int 2005; 25: 107-131.

34. Shemin D, Bostom AG, Laliberty P et al. Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis 2001; 38: 85-90.

35. Stack AG, Molony DA, Rahman NS et al. Impact of dialysis modality on survival of new ESRD patients with congestive hear failure in the United States. Kidney Int 2003; 64: 1071-1079.

36. Termorshuizen F, Korevaar JC, Dekker FW et al. Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis. Analysis of The Netherlands Cooperative Study on the Adequacy of dialysis 2. J Am Soc Nephrol 2003; 14: 2851-2860.

37. Twardowski ZJ. Clinical value of standardized equilibration tests in CAPD patients. Blood Purif 1989; 7: 95-108.

38. U.S. Renal Data System. Excerpts from the USRDS 2006 Annual Data Report. Am J Kidney Dis 2007; 49: 129-147.

39. Van Vlem B, Schoonjans RS, Struijk DG et al. Influence of dialysate on gastric emptying time in peritoneal dialysis patients. Per Dial Int 2002; 22: 32-38.

40. Vonesh EF, Snyder JJ, Foley RN et al. The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis. Kidney Int 2004; 66: 2389-2401.