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When to Initiate PD in the Diabetic Patient

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It is the general consensus that patients with diabetes should initiate dialysis at levels of   RRF that are higher than in patients with causes of ESRD other than diabetes1.  Some of the reasons for the early intervention are the accelerated loss of residual renal failure during the advanced stages of chronic renal insufficiency among diabetics, earlier / amplified uremic symptoms due to gastroparesis, autonomic neuropathy and fluid overload (nephrosis, CHF), and an attempt to improve nutrition. 

 

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References:

  1. KDOQI: Clinical Practice Guidelines for Peritoneal Dialysis Adequacy. Am J Kidney Dis 30:S67-S136, 1997
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