Renal Replacement Therapy in Patients with Diabetic Kidney Disease

Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease (CKD) worldwide and the disease is often relentless and progresses to end-stage kidney disease (ESKD). It is incumbent upon the treating team to prepare patients early, for future renal replacement therapy (RRT), helping them to choose their preferred modality of RRT, thus avoiding a “crash-start” on dialysis. Early construction of an arterio-venous fistula (AVF) avoids requirement of intravascular dialysis catheter insertion for dialysis, and this may slow down disease progression as well. Both peritoneal dialysis (PD) and hemodialysis (HD) are equally good options for RRT, and patients may choose between them. In general, kidney transplantation is better (in term of morbidity and mortality) than dialysis and must be considered for all.