Diabetic Patients on Peritoneal Dialysis

Passadakis, Ploumis; Oreopoulos, Dimitrios G.

doi:10.1111/j.1525-139x.2010.00707.x

Cited by 18 publications

(18 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Diabetic patients face the worst survival (3) both on hemodialysis (HD) and peritoneal dialysis (PD) and represent a challenge to the healthcare team. Debate considering which dialysis modality confers better survival to diabetics still remains, with conflicting reports (4,5).…”

mentioning

confidence: 99%

Better Outcomes of Peritoneal Dialysis in Diabetic Patients in Spite of Risk of Loss of Autonomy for Home Dialysis

et al. 2014

View full text Add to dashboard Cite

♦ Introduction: Diabetes mellitus is a leading cause of chronic renal failure, challenging therapy strategies. Patients with diabetes may benefit from peritoneal dialysis (PD) but higher technique failure is feared. Our purpose was to critically evaluate clinical outcomes of this modality in diabetics, in order to find quality improvement strategies in these risk patients. ♦ Methods: A registry-based study of 432 incident patients, 23% with diabetes, from a university hospital PD program was performed. Traditional methods (Kaplan-Meier, Cox models) and innovative survival analysis, taking competing risks into account, were performed, as well as exploring the trends in cohorts according to the decade of PD start. ♦ Results: In spite of the detrimental effect of diabetes in patient survival compared to non-diabetics (77%, 52% vs 86%, 71%, at 2 and 4 years, respectively; p < 0.0001) the hazard ratio (HR) for death decreased in the more contemporary cohort (0.303, 95% confidence interval (CI) 0.150 -0.614, p < 0.001). It is noteworthy that diabetes was not associated with lower technique survival: 74%, 51% vs 79%, 57%, at 2 and 4 years, respectively (p = not significant (NS)). On multivariate analysis, diabetes was an independent predictor for mortality, but not for technique failure. The hazard ratio (HR) for technique failure also decreased in the more recent cohort (0.566, 95% CI 0.348 -0.919, p = 0.021). Among reasons for transfer to hemodialysis, proportion of ultrafiltration failure was similar between groups (26% vs 22%, p = NS), but drop-out due to loss of autonomy occurred more in the group with diabetes (23% vs 5%, p = 0.004), mainly due to ischemic stroke. The hospitalization rate was also higher in diabetic patients (1.39 vs 0.84 episodes per patient-year (E/PY), p = 0.004) but the peritonitis rate was not increased (0.53 vs 0.61 E/PY, p = NS). ♦ Conclusion: PD was an effective long-term renal replacement therapy in diabetics, without higher rates of technique failure, ultrafiltration failure or peritonitis. Better outcomes were achieved in the contemporary cohort. The menace of autonomy loss due to stroke and higher hospitalization rates enhance the need for assisted PD strategies and better control of comorbidities.Perit Dial Int 2014; 34(7):775-780 www.PDIConnect.com epub ahead of print:

show abstract

mentioning

confidence: 99%

Better Outcomes of Peritoneal Dialysis in Diabetic Patients in Spite of Risk of Loss of Autonomy for Home Dialysis

et al. 2014

View full text Add to dashboard Cite

show abstract

“…However, in the study performed by Pasadakiss et al (2010) no evidence existed regarding that the diabetic patients receive insufficient dialysis in comparison with the non-diabetic patients (21). It seems that the reasons for low dialysis adequacy in patients with diabetes include vascular sequels (e.g.…”

Section: Discussionmentioning

confidence: 99%

Impact of Jacobson Relaxation on Dialysis Adequacy in ElderlyHemodialysis Patients

Shirin

Mehdi

2017

jgbfnm

View full text Add to dashboard Cite

Background: Dialysis adequacy is one of the determining factors for survival in elderly patients. Improving the dialysis adequacy highly affects the remission and prognosis of old dialysis patients. Current study was conducted to evaluate the effects of Jacobson relaxation technique on dialysis adequacy in elderly people, who are under dialysis treatment. Methods:ods: This is a clinical trial performed on 80 hemodialysis patients in two hemodialysis centers of Gonabad and Yazd, Iran, in 2013. The patients were selected through purposive sampling method, and randomly assigned into the two groups of control (n=40) and intervention (n=40). The participants in intervention group were provided by three sessions of relaxation training, and were asked to perform the relaxation daily for six weeks, while the control group just received the routine cares. Afterwards, the adequacy of dialysis was compared between the two groups. The data was collected using the demographic information, and the dialysis adequacy was calculated by KT/V equation.Results: A significant statistical difference was found between groups regarding the mean difference of dialysis adequacy in pre-and post-intervention (P<0.001).Besides, dialysis adequacy increased post-intervention in the case group and decreased slightly in the control group compared to pre-intervention. Conclusion:Training and performing the relaxation method lead to an improved dialysis adequacy in elderly patients under hemodialysis.

show abstract

“…The presence of more morbidity factors at starting PD and a higher rate of previous cardiovascular events in diabetic patients may explain part of this risk [45, 46]. Added reasons for the reported worse outcome might be the variations in fluid homeostasis and corporal composition in diabetic patients, as fluid overload is the main cause of death in ESRD dialysis patients, and fluid control is potentially more difficult in PD diabetic patients [47]. Adjusted therapy is mandatory since results might differ according to treatment skills and policies.…”

Section: Controversy On Survival Datamentioning

confidence: 99%

“…It was demonstrated that GDP rich solutions accelerate leucocyte apoptosis and adversely affect the peritoneal defense [67]. However, neither peritonitis episodes nor other PD related infections have been observed to be more common in diabetic than in nondiabetic patients [47]. Several articles report, notwithstanding the risks presented, no difference in technique survival between diabetics and nondiabetic dialysis group of patients [49].…”

Section: Peritoneal Dialysis Risks In Diabeticsmentioning

confidence: 99%

Peritoneal Dialysis in Diabetics: There Is Room for More

Cotovio¹,

Rocha

Rodrigues

2011

International Journal of Nephrology

View full text Add to dashboard Cite

End stage renal disease diabetic patients suffer from worse clinical outcomes under dialysis-independently of modality. Peritoneal dialysis offers them the advantages of home therapy while sparing their frail vascular capital and preserving residual renal function. Other benefits and potential risks deserve discussion. Predialysis intervention with early nephrology referral, patient education, and multidisciplinary support are recommended. Skilled and updated peritoneal dialysis protocols must be prescribed to assure better survival. Optimized volume control, glucose-sparing peritoneal dialysis regimens, and elective use of icodextrin are key therapy strategies. Nutritional evaluation and support, preferential use of low-glucose degradation products solutions, and prescription of renin-angiotensin-aldosterone system acting drugs should also be part of the panel to improve diabetic care under peritoneal dialysis.

show abstract

Diabetic Patients on Peritoneal Dialysis

Cited by 18 publications

References 19 publications

Better Outcomes of Peritoneal Dialysis in Diabetic Patients in Spite of Risk of Loss of Autonomy for Home Dialysis

Better Outcomes of Peritoneal Dialysis in Diabetic Patients in Spite of Risk of Loss of Autonomy for Home Dialysis

Impact of Jacobson Relaxation on Dialysis Adequacy in ElderlyHemodialysis Patients

Peritoneal Dialysis in Diabetics: There Is Room for More

Contact Info

Product

Resources

About