Long-Term Follow-Up of peritoneal dialysis for diabetic nephropathy
DOI:
https://doi.org/10.5281/zenodo.22813031Keywords:
peritoneal dialysis, diabetic nephropathy, technique survival, peritonitis, residual renal functionAbstract
Background: Diabetic nephropathy is the leading cause of end-stage renal disease in most health systems, and peritoneal dialysis offers hemodynamic and residual-renal-function advantages for this population, offset by the metabolic cost of dextrose-based osmotic exchange.
Objective: This review synthesizes long-term follow-up evidence on peritoneal dialysis outcomes in diabetic nephropathy across patient and technique survival, peritonitis risk, metabolic and membrane change, and cardiovascular outcomes.
Methods: We synthesized cohort studies, national and multinational renal registry analyses, randomized trials of peritoneal dialysis solutions, and systematic reviews reporting diabetes-stratified peritoneal dialysis outcomes over multi-year follow-up.
Findings: Modern propensity-matched analyses show mortality broadly comparable between peritoneal dialysis and hemodialysis in diabetic patients, while technique survival remains diabetes-disadvantaged, driven by elevated peritonitis risk and progressive glucose-exposure-related peritoneal membrane change that erodes ultrafiltration capacity; glucose-sparing strategies such as icodextrin help preserve ultrafiltration over time.
Conclusions: Long-term peritoneal dialysis remains a reasonable long-term modality for diabetic nephropathy, provided infection surveillance, periodic membrane function testing, and residual renal function preservation are actively pursued throughout follow-up.
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