Peritoneal Dialysis Care for People with Diabetes, Polycystic Kidney Disease, or Advanced Liver Disease

Clin J Am Soc Nephrol. 2024 Jan 8. doi: 10.2215/CJN.0000000000000420. Online ahead of print.ABSTRACTPeople treated with peritoneal dialysis (PD) often have complicating conditions that require careful management. Three such conditions are reviewed in this article - diabetes mellitus, polycystic kidney disease (PKD) and chronic liver disease. Each of these conditions requires an understanding of both its impact on the delivery of the PD, as well as the impact of the PD on the condition itself. With respect to diabetes, glucose absorption from the dialysate complicates metabolic control, impacts on salt and water management and on patient outcome. There is particular benefit in clinical care being delivered through a multidisciplinary team that involves both kidney and diabetes experts. In relation to PKD, a key issue is the potential for increased intraperitoneal pressure due to the combined effect of the enlarged polycystic organs and the presence of the dialysis solution and therefore the PD prescription requires to be managed with a particular focus on limiting that pressure. For patients with liver disease key issues include nutritional support since PD can add to protein losses already consequent on the liver disease itself. Considered approaches are required to manage ascites, reduce infection risk and the potential for hernias and leaks to develop. Mortality in this group is unfortunately high - however PD may present a better management option than hemodialysis in many...
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Source Type: research