{"id":908,"date":"2020-03-12T04:54:59","date_gmt":"2020-03-12T09:54:59","guid":{"rendered":"https:\/\/staging.advancedrenaleducation.com\/wparep\/?post_type=article&#038;p=908"},"modified":"2025-05-09T17:35:26","modified_gmt":"2025-05-09T22:35:26","slug":"pd-prescriptions-for-diabetics","status":"publish","type":"article","link":"https:\/\/staging.advancedrenaleducation.com\/wparep\/article\/pd-prescriptions-for-diabetics\/","title":{"rendered":"PD Prescriptions for Diabetics"},"content":{"rendered":"<p><span data-contrast=\"auto\">D<\/span><span data-contrast=\"auto\">iabetes is one of the primary causes of end stage renal disease (ESRD)\u00a0<\/span><span data-contrast=\"auto\">with roughly 40% of CKD patients presenting with diabetes,\u00a0<\/span><span data-contrast=\"auto\">deeming itself to be\u00a0<\/span><span data-contrast=\"auto\">an important\u00a0<\/span><span data-contrast=\"auto\">condition in th<\/span><span data-contrast=\"auto\">e ESRD<\/span><span data-contrast=\"auto\">\u00a0population<\/span><span data-contrast=\"auto\">s (<\/span><span data-contrast=\"auto\">1)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">Compared to non-diabetic patients, diabetic patients have a higher risk for comorbidities and complications, including cardiovascular disease, inadequate fluid balance,<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">a<\/span><span data-contrast=\"auto\">\u00a0decreased quality of life<\/span><span data-contrast=\"auto\">, and<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">a decline in reserved renal function (<\/span><span data-contrast=\"auto\">2,3)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">Diabetic patients\u00a0<\/span><span data-contrast=\"auto\">also\u00a0<\/span><span data-contrast=\"auto\">suffer from worse outcomes related to morbidity and mortality\u00a0<\/span><span data-contrast=\"auto\">along with high technique failure rates after dialysis initiation (<\/span><span data-contrast=\"auto\">2,4)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">When determining a\u00a0<\/span><span data-contrast=\"auto\">peritoneal\u00a0<\/span><span data-contrast=\"auto\">dialysis\u00a0<\/span><span data-contrast=\"auto\">(PD)\u00a0<\/span><span data-contrast=\"auto\">prescription<\/span><span data-contrast=\"auto\">\u00a0for a\u00a0<\/span><span data-contrast=\"auto\">diabetic\u00a0<\/span><span data-contrast=\"auto\">patient<\/span><span data-contrast=\"auto\">,\u00a0<\/span><span data-contrast=\"auto\">all of<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">these parameters\u00a0<\/span><span data-contrast=\"auto\">must<\/span><span data-contrast=\"auto\">\u00a0be taken into consideration<\/span><span data-contrast=\"auto\">.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Regarding\u00a0<\/span><span data-contrast=\"auto\">dialysis\u00a0<\/span><span data-contrast=\"auto\">adequacy,\u00a0<\/span><span data-contrast=\"auto\">t<\/span><span data-contrast=\"auto\">he K\/DOQI workgroup\u00a0<\/span><span data-contrast=\"auto\">recommends<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">a\u00a0<\/span><span data-contrast=\"auto\">targe<\/span><span data-contrast=\"auto\">t<\/span><span data-contrast=\"auto\">\u00a0Kt\/<\/span><span data-contrast=\"auto\">V<\/span><span data-contrast=\"auto\">urea<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">of\u00a0<\/span><span data-contrast=\"auto\">at least<\/span><span data-contrast=\"auto\">\u00a01.7\u00a0<\/span><span data-contrast=\"auto\">per week<\/span><span data-contrast=\"auto\">\u00a0in all PD patients (<\/span><span data-contrast=\"auto\">5)<\/span><span data-contrast=\"auto\">. In the ADEMEX study, which evaluated PD prescription outcomes based on clearance, the diabetic subgroup had identical results to the whole group demonstrating that diabetic patients could potentially follow\u00a0<\/span><span data-contrast=\"auto\">t<\/span><span data-contrast=\"auto\">he K\/DOQI recommendations for Kt\/<\/span><span data-contrast=\"auto\">V<\/span><span data-contrast=\"auto\">urea<\/span><span data-contrast=\"auto\">\u00a0targets (<\/span><span data-contrast=\"auto\">6)<\/span><span data-contrast=\"auto\">. Overall, the Kt\/<\/span><span data-contrast=\"auto\">V<\/span><span data-contrast=\"auto\">urea<\/span><span data-contrast=\"auto\">\u00a0should be tailored to each individual patient\u2019s response.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The PD prescription\u00a0<\/span><span data-contrast=\"auto\">for<\/span><span data-contrast=\"auto\">\u00a0all patients, including<\/span><span data-contrast=\"auto\">\u00a0diabetic patients\u00a0<\/span><span data-contrast=\"auto\">should be based on<\/span><span data-contrast=\"auto\">\u00a0the treatment goals for the individual patient,<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">kinetic modelling<\/span><span data-contrast=\"auto\">,<\/span><span data-contrast=\"auto\">\u00a0and patient\u2019s preference.<\/span><span data-contrast=\"auto\">\u00a0Clinical evaluation including hydration, nutrition, hypertension, and glycemic control should be incorporated.\u00a0<\/span><span data-contrast=\"auto\">The four main factors that affect peritoneal clearance are patient transport type, total dialysate volume, dwell time, and ultrafiltration volume.\u00a0<\/span><span data-contrast=\"auto\">When evaluating the PD prescription<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">one month after starting on PD<\/span><span data-contrast=\"auto\">, the recommended test must be used to measure peritoneal transport, ultrafiltration, and clearance. The most common tests are the Peritoneal Equilibration Test, or PET, and a 24-hour batch collection. The PET measures transport status and ultrafiltration while the 24-hour batch measures peritoneal clearance, residual renal function, and ultrafiltration. It can also monitor nutritional status (<\/span><span data-contrast=\"auto\">7)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The management of volume in patients with diabetes on peritoneal dialysis is affected by several factors, including the degree of residual renal function, peritoneal membrane small-solute transport, salt and water intake, blood sugar control, comorbidity, and nutritional status.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/p>\n<ul>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">As with non-diabetic PD patients, transport type in diabetics is patient-specific and should be considered when determining appropriate dwell times for clearance and ultrafiltration.\u00a0\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">With dialysate volume, more volume<\/span><span data-contrast=\"auto\">\u00a0can help to<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">increase<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">urea\u00a0<\/span><span data-contrast=\"auto\">clearance. Volume can be adjusted by increasing the number of exchanges or the volume of individual dwells.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">Individualizing dwell times for maximal UF is critical. Dwell time should be based on transport type and clinical needs.\u00a0<\/span><span data-contrast=\"auto\">Based on the modeled ultrafiltration profiles of an average transporter, the peak ultrafiltration times vary from 3 hours, with 1.5% dextrose solution, to 6 hours with 4.25% dextrose solution (<\/span><span data-contrast=\"auto\">8)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">Most of the d<\/span><span data-contrast=\"auto\">iabetic p<\/span><span data-contrast=\"auto\">atients<\/span><span data-contrast=\"auto\">\u00a0tend to<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">be high transporters\u00a0<\/span><span data-contrast=\"auto\">and\u00a0<\/span><span data-contrast=\"auto\">have<\/span><span data-contrast=\"auto\">\u00a0been shown to have evidence<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">of intraperitoneal inflammation (<\/span><span data-contrast=\"auto\">9)<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">and do less well on continuous ambulatory peritoneal dialysis (CAPD) (<\/span><span data-contrast=\"auto\">10)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"none\">The principal strategies to manage\u00a0<\/span><span data-contrast=\"none\">the\u00a0<\/span><span data-contrast=\"auto\">prescriptions for diabetic\u2019s patients may\u00a0<\/span><span data-contrast=\"auto\">include the\u00a0<\/span><span data-contrast=\"auto\">use APD to deliver shorter dwell times as well as higher dialysate glucose concentrations to avoid reabsorption of fluid<\/span><span data-contrast=\"none\">.\u00a0<\/span><span data-contrast=\"none\">Additionally,\u00a0<\/span><span data-contrast=\"none\">the studies<\/span><span data-contrast=\"none\">\u00a0have showed that c<\/span><span data-contrast=\"none\">ompared with CAPD, APD might reduce glucose fluctuation in diabetic PD patients (<\/span><span data-contrast=\"none\">11,12)<\/span><span data-contrast=\"none\">.<\/span><span data-contrast=\"none\">\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"none\">Dialysate glucose\u00a0<\/span><span data-contrast=\"none\">may be\u00a0<\/span><span data-contrast=\"none\">increased to augment UF; however, this\u00a0<\/span><span data-contrast=\"none\">needs to be<\/span><span data-contrast=\"none\">\u00a0done cautiously because of concerns regarding glucose exposure<\/span><span data-contrast=\"none\">\u00a0in these\u00a0<\/span><span data-contrast=\"none\">patients<\/span><span data-contrast=\"none\">.<\/span><span data-contrast=\"none\">\u00a0<\/span><span data-contrast=\"auto\">Glucose as an osmotic agent is associated with hyperglycemia, hyperinsulinemia, and obesity, and is a poor option in diabetics because glucose is rapidly absorbed (<\/span><span data-contrast=\"auto\">13)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"none\">I<\/span><span data-contrast=\"auto\">t is\u00a0<\/span><span data-contrast=\"auto\">important to note that t<\/span><span data-contrast=\"auto\">he ratio of net UF volume per gram of glucose absorbed is higher<\/span><span data-contrast=\"auto\">\u00a0with short cycles than with the longer cycles of CAPD (<\/span><span data-contrast=\"auto\">14)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">Average systemic glucose absorption from repeated exposure to PD solutions ranges between 100 and 300 g\/day (<\/span><span data-contrast=\"auto\">8)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">The caloric intake from a CAPD regimen can be estimated by multiplying the amount of total glucose absorbed (60\u201380%) by 3.7 (conversion factor for gram to kcal).\u00a0<\/span><span data-contrast=\"auto\">Whereas<\/span><span data-contrast=\"auto\">, the caloric intake from shorter automated PD dwells is estimated to be lower at 40\u201350% (<\/span><span data-contrast=\"auto\">15)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">Thus,\u00a0<\/span><span data-contrast=\"auto\">adjusting the dextrose strength of the dialysate<\/span><span data-contrast=\"auto\">\u00a0can help achieve<\/span><span data-contrast=\"auto\">\u00a0optimal\u00a0<\/span><span data-contrast=\"auto\">UF<\/span><span data-contrast=\"auto\">; and, when appropriate, icodextrin can be considered for long dwells<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/li>\n<li data-leveltext=\"\uf0b7\" data-font=\"Symbol\" data-listid=\"6\" data-aria-posinset=\"1\" data-aria-level=\"1\"><span data-contrast=\"auto\">Icodextrin<\/span><span data-contrast=\"auto\">\u00a0is an alternative PD solution\u00a0<\/span><span data-contrast=\"auto\">osmotic agent which<\/span><span data-contrast=\"auto\">\u00a0lacks the metabolic effects of glucose<\/span><span data-contrast=\"auto\">, is absorbed slower than glucose, and allows for prolonged\u00a0<\/span><span data-contrast=\"auto\">peritoneal\u00a0<\/span><span data-contrast=\"auto\">ultrafiltration<\/span><span data-contrast=\"auto\">\u00a0with enhanced fluid removal (<\/span><span data-contrast=\"auto\">3,13)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">The modification of\u00a0<\/span><span data-contrast=\"auto\">the<\/span><span data-contrast=\"auto\">\u00a0prescription\u00a0<\/span><span data-contrast=\"auto\">by including<\/span><span data-contrast=\"auto\">\u00a0the use of an icodextrin exchange during the day<\/span><span data-contrast=\"auto\">\u00a0may\u00a0<\/span><span data-contrast=\"auto\">provide sustained UF over a longer dwell, despite the fast transport status, because it makes use of the effectively increased peritoneal surface area in this patient population (<\/span><span data-contrast=\"auto\">16)<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">Thus,\u00a0<\/span><span data-contrast=\"auto\">icodextrin has\u00a0<\/span><span data-contrast=\"auto\">been suggested to be an appropriate osmotic agent in diabetic patients due to its ability<\/span><span data-contrast=\"auto\">\u00a0to reduce serum insulin levels,\u00a0<\/span><span data-contrast=\"auto\">improve insulin sensitivity<\/span><span data-contrast=\"auto\">, and better control glucose in diabetic patients (<\/span><span data-contrast=\"auto\">2,13)<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">Euvolemia is an important adequacy parameter in peritoneal dialysis (PD) patients<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">Diabetic peritoneal dialysis patients have been reported to have faster peritoneal solute transport and may be at risk of reduced ultrafiltration volumes, leading to fluid overload<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">It is\u00a0<\/span><span data-contrast=\"auto\">also\u00a0<\/span><span data-contrast=\"auto\">suggested<\/span><span data-contrast=\"auto\">\u00a0that diabetic peritoneal dialysis patients have an expanded extracellular volume (<\/span><span data-contrast=\"auto\">17)<\/span><span data-contrast=\"auto\">.\u00a0\u00a0<\/span><span data-contrast=\"auto\">An important aspect of fluid balance in PD patients is sodium removal. Sodium removal is largely<\/span><span data-contrast=\"auto\">\u00a0dependent on\u00a0<\/span><span data-contrast=\"auto\">sodium sieving and ultrafiltration<\/span><span data-contrast=\"auto\">\u00a0rate. Additionally, sodium removal correlates heavily with ultrafiltration volume for all solution types.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">Sodium sieving occurs particularly when using high glucose concentrations.\u00a0<\/span><span data-contrast=\"auto\">Sieving impairs sodium removal in too short cycles,<\/span><span data-contrast=\"auto\">\u00a0and<\/span><span data-contrast=\"auto\">\u00a0reabsorption in too long cycles.\u00a0<\/span><span data-contrast=\"auto\">Thus,<\/span><span data-contrast=\"auto\">\u00a0maximizing the PD prescription for time to peak UF also maximizes sodium removal.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Furthermore, the adjustment of the prescription<\/span><span data-contrast=\"auto\">\u00a0for diabetic PD patients\u00a0<\/span><span data-contrast=\"auto\">should be based on frequent blood glucose determinations and hemoglobin A1c (HA1c).<\/span><span data-contrast=\"auto\">\u00a0T<\/span><span data-contrast=\"auto\">herapeutic actions\u00a0<\/span><span data-contrast=\"auto\">that\u00a0<\/span><span data-contrast=\"auto\">include stepwise<\/span><span data-contrast=\"auto\">\u00a0addition of oral hypoglycemic agents and insulin, based on individual assessment of PD patients<\/span><span data-contrast=\"auto\">\u00a0should be considered to manage\u00a0<\/span><span data-contrast=\"auto\">the hyperglycemia.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">In addition to peritoneal dialysis prescription adjustments, i<\/span><span data-contrast=\"auto\">t may be necessary to incorporate dietary\u00a0<\/span><span data-contrast=\"auto\">counseling such as dietary<\/span><span data-contrast=\"auto\">\u00a0salt and fluid restriction may help reduce the use of hypertonic glucose solution and thus facilitate the blood glucose control in diabetic patients undergoing peritoneal dialysis.<\/span><span data-contrast=\"auto\">\u00a0Also,<\/span><span data-contrast=\"auto\">\u00a0oral nutritional supplements, hypolipidemic drugs\u00a0<\/span><span data-contrast=\"auto\">for control of\u00a0<\/span><span data-contrast=\"auto\">serum lipid<\/span><span data-contrast=\"auto\">s,\u00a0<\/span><span data-contrast=\"auto\">and education on the limitation of simple sugars and saturated fats\u00a0<\/span><span data-contrast=\"auto\">depending on\u00a0<\/span><span data-contrast=\"auto\">the patient\u2019s nutritional status (<\/span><span data-contrast=\"auto\">18,19)<\/span><span data-contrast=\"auto\">.\u00a0<\/span><span data-contrast=\"auto\">Reduction of urinary and peritoneal protein loss<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">and preservation of RRF with early initiation of ACEIs or ARBs after the start of PD therapy are also important.\u00a0<\/span><span data-contrast=\"auto\">A decrease in proteinuria with the use of angiotensin converting enzyme inhibitors (ACEIs) in patients with diabetic nephropathy is well recognized (<\/span><span data-contrast=\"auto\">20,21)<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">With better glycemic control, improved nutrition, improved fluid balance,\u00a0<\/span><span data-contrast=\"auto\">may aid\u00a0<\/span><span data-contrast=\"auto\">in<\/span><span data-contrast=\"auto\">\u00a0preservation of residual renal function<\/span><span data-contrast=\"auto\">.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559739&quot;:0,&quot;335559740&quot;:360}\">\u00a0<\/span><\/p>\n<div class=\"vcex-spacing\"><div class=\"vcex-spacing\" style=\"height:30px\"><\/div><\/div>\n<h4>\u00a0References:<\/h4>\n<ol>\n<li><i><span data-contrast=\"auto\">United States Renal Data System. 2016 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2016.<\/span><\/i><span data-contrast=\"auto\">; 2016.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559685&quot;:640,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:360,&quot;335559991&quot;:640}\">\u00a0<\/span><\/li>\n<li><span data-contrast=\"auto\">Yao Q, Lindholm B, Heimb\u00fcrger O. Peritoneal dialysis prescription for diabetic patients.<\/span><i><span data-contrast=\"auto\">Perit Dial Int<\/span><\/i><span data-contrast=\"auto\">. 2005;25 Suppl 3:S76-9. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16048263.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559685&quot;:640,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:360,&quot;335559991&quot;:640}\">\u00a0<\/span><\/li>\n<li><span data-contrast=\"auto\">Kuriyama S. Peritoneal dialysis in patients with diabetes: are the benefits greater than the disadvantages?<\/span><i><span data-contrast=\"auto\">Perit Dial Int<\/span><\/i><span data-contrast=\"auto\">. 2007;27 Suppl 2:S190-5. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17556303.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559685&quot;:640,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:360,&quot;335559991&quot;:640}\">\u00a0<\/span><\/li>\n<li><span data-contrast=\"auto\">Cotovio P, Rocha A, Rodrigues A. Peritoneal dialysis in diabetics: there is room for more.<\/span><i><span data-contrast=\"auto\">Int J Nephrol<\/span><\/i><span data-contrast=\"auto\">. 2011;2011:914849. 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Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial.<\/span><i><span data-contrast=\"auto\">J Am Soc Nephrol<\/span><\/i><span data-contrast=\"auto\">. 2002;13(5):1307-1320.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559685&quot;:640,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:360,&quot;335559991&quot;:640}\">\u00a0<\/span><\/li>\n<li><i><span data-contrast=\"auto\">Hemodialysis Adequacy Peritoneal Dialysis Adequacy Vascular Access A Curriculum for CKD Risk Reduction and Care Kidney Learning System (KLS)<\/span><\/i><i><span data-contrast=\"auto\">TM<\/span><\/i><i><span data-contrast=\"auto\">2006 Updates Clinical Practice Guidelines and Recommendations<\/span><\/i><span data-contrast=\"auto\">. 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Effects of different antihypertensive drugs on human diabetic proteinuria.<\/span><i><span data-contrast=\"auto\">Nephrol Dial Transpl<\/span><\/i><span data-contrast=\"auto\">. 1993;8(5824).<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559685&quot;:640,&quot;335559738&quot;:240,&quot;335559739&quot;:240,&quot;335559740&quot;:360,&quot;335559991&quot;:640}\">\u00a0<\/span><\/li>\n<\/ol>\n<p><span data-contrast=\"auto\">P\/N 102539-01 Rev<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\">A<\/span><span data-contrast=\"auto\">\u00a00<\/span><span data-contrast=\"auto\">3<\/span><span data-contrast=\"auto\">\/20<\/span><span data-contrast=\"auto\">20<\/span><span data-ccp-props=\"{&quot;201341983&quot;:2,&quot;335559685&quot;:360,&quot;335559739&quot;:240,&quot;335559740&quot;:240,&quot;335559991&quot;:360}\">\u00a0<\/span><\/p>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div>\n","protected":false},"featured_media":0,"template":"","format":"standard","meta":{"_acf_changed":false},"categories":[5],"tags":[142],"language":[41],"articles":[266],"class_list":["post-908","article","type-article","status-publish","format-standard","hentry","category-articles","tag-diabetes-manage","language-english","articles-peritoneal-dialysis","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.2 - 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