Table 2.

Composition of end stage renal disease options for diabetic patients

Factor Peritoneal Dialysis Hemodialysis Kidney Transplant
Extrarenal disease No limitation No if hypotensive No if severe heart disease
Geriatric patients No limitation No limitation Arbitrary by program
Full rehabilitation Rare, if ever Rare Common with graft functions
Death rate Higher than non-diabetics Higher than non-diabetics Slightly higher than non-diabetics
First year survival About 75–80% About 75–80% Above 95%
Survival >10 years Almost never Fewer than 5% About one-half
Complications of diabetes Usual plus hyperglycemia and hyperlipidemia Usual for diabetes Reduced by functioning transplant
Special advantage Self-performed. No swings in blood volume level. Can be self-performed. Efficient. Travel freedom. Eye and nerve problems may improve
Disadvantage Peritonitis. Long hours of treatment. More days hospitalized. Clotting or infected access. Depression, weakness Cosmetic disfigurement, Cost of cytotoxic drugs. Induced malignancy. HIV transmission.
Patient acceptance Variable, usual passive tolerance for regimen. Variable, usual passive tolerance for regimen. Enthusiastic so long as graft functions. Exalted when pancreas normalizes glucose
Biased comparisons First choice by enthusiasts, long-term fatigue and switch to hemodialysis. Default for >80%. Complicated by heart and vascular disease. Selection of healthiest and youngest patients favorably predjudices outcome.
Relative cost First year less than kidney transplant, subsequent years more expensive. First year less than transplant, subsequent years more expensive. After first year, kidney transplant — alone — lowest cost option.
RMMJ Rambam Maimonides Medical Journal Rambam Health Care Campus 2010 July; 1(1): e0005. ISSN: 2076-9172
Published online 2010 July 2. doi: 10.5041/RMMJ.10005.