Mortality predictor pattern in hemodialysis and peritoneal dialysis in diabetic patients.

An excessive mortality in dialysis programs is the result of cardiovascular injuries and immune deficiency caused by uremic toxins. The vulnerability of dialysis patients is still increasing due to the growing number of diabetics, elderly and patients with a history of cardiovascular disease. Peritoneal dialysis (PD) and hemodialysis (HD) offer similar effectiveness during the first 2 years of the treatment. However, the survival advantage of HD subsequently appears. The problem of the factors responsible for the mortality during long-term PD and HD treatment was analyzed in our recently published investigation. A lower death risk for PD patients during the first several months was lessened over time, and, therefore, no survival advantage of PD was noticeable by the completion of the 2-year period. A sign of the diminishing benefit of PD was a high rate of modality switch - 57%, contrasting with 6% switched in the HD group. Longer observations confirmed that the extension of the treatment period above 2 years with HD was associated with improved survival among subgroups with cardiovascular disease and diabetes. A very relevant problem is the timely transfer of PD patients to the HD program, when an adequate nutritional intake cannot be ascertained and a decline of serum albumin level is observed. The aim of this overview was to compare the factors affecting the survival of diabetic patients in HD and PD patients.