Composition of end stage renal disease options for diabetic patients
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. |