Continuous ambulatory peritoneal dialysis in 224 diabetics with end stage renal disease: evidence of improved survival over the past 10 years

Dating back to its earliest application in diabetic ESRD patients, Oreopoulos has championed peritoneal dialysis. In the present update of an experience with 224 diabetic patients, peritonitis, the technique limiting complication of peritoneal dialysis, was reduced to about one episode in 16–19 months, an impressive accomplishment. Survival increased to a remarkable 93% at one year and 70% after three years. By five years, however, two-thirds of patients were dead, the consequence of unrelenting comorbidity. Assigning a place for peritoneal dialysis as opposed to hemodialysis as a first choice regimen for diabetic patients with ESRD is more a matter of bias and personal experience than of objective data analysis. In Canada, 52% of diabetic patients were receiving peritoneal dialysis three months after initiation of dialytic therapy while in the United States fewer than 20% are similarly treated. Why? Enthusiasts like Oreopoulos have advanced acceptance of peritoneal dialysis by demonstrating that it can be performed with high patient acceptance, lower cost than hemodialysis, and superior patient survival. Lacking the commitment and expertise of physicians dedicated to peritoneal dialysis, nephrologists are unlikely to gain results that meet the standard of excellence exemplified by the present report.