Pd for a diabetic person

I am Roja from Iran.One of my relatives has lot problem with dialysis .He is 65 years old.has heart problems (he has had several mild MI in his life).he has diabe (he needs ansulin).He is doing HD once in 2 days and he cant transplant kidney ecause of his heart problems and other.Few days ago we understood that he has problem with one of his fingers,there was a black area (2*2 cm)on his hand with pain, I think it is a necrosed place.doctors put change the place of catheter from his hand to his neck.it seems that diagnose was right ,but his hand isnt going better.he is in trouble with dialise and pain and…
My question is :isnt PD better for him?we are afraid of peritonitis because of his diabet.and I think they cant give a nurse at home.what do u hink what he must do now?

Hi Roja, and welcome to Home Dialysis Central. If your relative is a large man (does he have type 2 diabetes? is he very overweight), a very large study–134,728 new patients with kidney failure–found that survival was better on hemo than on PD.

The abstract is pretty technical, but in case you find it useful:

Kidney Int. 2004 Jun;65(6):2398-408. s
Comment in: Kidney Int. 2005 Apr;67(4):1637.
Survival differences between peritoneal dialysis and hemodialysis among “large” ESRD patients in the United States.

Stack AG,
Murthy BV,
Molony DA.

BACKGROUND: It has been hypothesized that peritoneal dialysis compared to hemodialysis may be less effective in large patients with end-stage renal disease (ESRD). METHODS: We tested this hypothesis in a cohort of 134,728 new ESRD patients who were initiated on dialysis from May 1, 1995 to July 31, 1997 using data from United States Renal Data System (USRDS). Cox regression models evaluated the association of body mass index (BMI) in quintiles (8.8-20.9, 20.9-23.5, 23.5-26.1, 26.1-30.0, 30.0-75.2 kg/m(2)) with mortality over 2 years in peritoneal dialysis and hemodialysis patients separately, while time-dependent models evaluated the relative risk (RR) of death by modality for each BMI quintile. RESULTS: For hemodialysis, the adjusted RR of death was greatest for patients with BMI <or = 20.9 (RR = 1.40, 95% CI 1.32-1.50 for diabetics and RR = 1.27, 95% CI 1.21-1.34 for nondiabetics) and lowest for patients with BMI >30.0 (RR = 0.97, 95% CI 0.96-0.99 for diabetic and RR = 0.97, 95% CI 0.95-0.98 for nondiabetic patients) compared with the referent (23.5-26.1; RR = 1.00). For peritoneal dialysis, the RR of death was also higher for patients with a BMI <20.9 (RR = 1.20, 95% CI 1.00-1.43 for diabetic and RR = 1.39, 95% CI 1.19-1.64 for nondiabetic patients) but no survival advantage was associated with higher BMI values. The RR of death (peritoneal dialysis/hemodialysis) for each BMI quintile was 0.99, 1.12, 1.26 (P < 0.01), 1.15 (P < 0.01), and 1.44 (P < 0.0001) for diabetic and were 1.07, 1.01, 0.96, 1.04, and 1.22 (P < 0.01) for nondiabetic patients, respectively. CONCLUSION: We conclude that body size modifies the impact of dialysis modality on mortality risk among new ESRD patients in the United States. The selection of hemodialysis over peritoneal dialysis was associated with a survival advantage in patients with large body habitus.