Questions About PD
The advantages in diabetic patients are similar to those for all PD patients, including greater autonomy, flexibility, fewer hospital visits and better preservation of residual renal function. A potential disadvantage is hyperglycemia and weight gain as a result of the hypertonic glucose solutions that are used. This issue can be mitigated by adjustment of oral hypoglycemics/insulin to maintain optimal glucose control, and by tailoring of the PD prescription to minimize glucose absorption. This tailoring would include adjusting dwell times based on transport status (shorter dwells if rapid transporter) and addition of icodextrin. Since icodextrin is a glucose polymer, it does not lead to significant glucose absorption, and use of icodextrin for the long dwell will allow for better UF and therefore less use of hypertonic solutions for the other exchanges.