Elderly Diabetic Patients on Peritoneal Dialysis

摘要

Diabetes mellitus is the fastest-growing cause of end-stage renal disease (ESRD) among patients requiring renal replacement therapy (RRT). While diabetes mellitus has become the leading cause of ESRD, the number of elderly patients who need dialysis has grown almost exponentially. Most elderly patients with diabetes are treated with hemo-dialysis; only a small percentage are treated with peritoneal dialysis (PD). Elderly PD patients with diabetes have a lower survival rate than do nondiabetic patients and younger diabetic patients, perhaps because of the increased comorbidity seen in diabetic patients at dialysis initiation. Also, diabetic patients on RRT are at higher risk of developing de novo cardiovascular disease, one of the major causes of mortality. In Canada, survival in elderly diabetic patients undergoing PD is similar to that in hemodialysis patients; in the United States, patients over 45 -55 years of age with diabetes have experienced higher mortality on PD than on hemodialysis. It is important, however, to emphasize that survival on PD in these elderly patients has greatly improved in recent years. Fluid volume expansion may be one of the reasons for the higher mortality in elderly diabetic patients in some countries; but overall, PD remains a viable form of long-term RRT for elderly diabetic patients with ESRD.