Aspectos diferenciales del manejo del paciente diabético con insuficiencia renal en diálisis peritoneal o hemodiálisis Differential aspects in management of diabetic patient with renal insufficiency under peritoneal dialysis or hemodialysis

Although the appearance and progression of diabetic nephropathy may be retarded by normalization of the blood pressure, tight glycemic control and management of other risk factors, many patients still progress to end-stage renal disease. Over the last 15 to 20 years, it has been observed a progressive increment of type 2 diabetic patients developing end-stage renal disease. The underlying reasons for this increase are multiple. Among the most important are the development of diabetes at earlier age and better survival of patients, especially those at higher vascular risk. Diabetic patients have lower survival on dialysis than non-diabetic patients. Cardiovascular complications are the most important cause death (~50%), also conditioning prognosis if they are present before dialysis is initiated. However, in the last years, morbidity and mortality of patients in dialysis has signifi cantly improved. Furthermore, diabetic patients undergoing renal transplantation have even better survival, quality of life and an improved degree of rehabilitation than those in dialysis therapy, due in part to selection bias of transplant candidates. Among hemodialysis or continuous ambulatory peritoneal dialysis (CAPD), there are no clear differences on survival or morbidity. Although it was accepted that CAPD was associated with better survival rates, recent data from the USRDS suggest that mortality may be increased in diabetic patients treated with CAPD rather than with hemodialysis. Therefore, currently no signifi cant differences in survival can be established in diabetic patients treated either with hemodialysis or CAPD.