以末期腎臟病(end-stage renal disease; ESRD)的盛行率來看，近年來台灣高居全球第一位。對ESRD患者而言，透析實際上是較普及的治療方法。目前台灣約有一成的健保支出是耗用於ESRD的透析治療上，且每年新增洗腎患者達八千人以上。分析透析盛行個案的原發病因，其中糖尿病佔了近30%，僅次於腎絲球腎炎。而以新發個案而言，原發病因為糖尿病者則佔了四成，高居第一位。對一般患者而言，使用腹膜透析(peritoneal dialysis; PD)或血液透析(hemodialysis; HD)何者為佳尚未有定論。而針對為數眾多的糖尿病ESRD患者來說，由於糖尿病的影響則更可能引發或潛藏各項代謝、血管與神經併發症。因此本文以文獻回顧，分析HD與PD的優缺點與糖尿病患者使用HD或PD所可能衍生的問題，目的為找出適合糖尿病ESRD患者的透析方法。本文綜合文獻論述，在以糖尿病患者的健康為優先考量下，針對台灣地區之醫療現況，考慮患者之身體狀況、飲食作息、血糖控制、血壓高低、感染危險，以及其是否合併大血管疾病、營養或脂質代謝障礙，或是否仍保有殘餘腎功能等差異，提出一套可行的流程建議。
Taiwan has the highest prevalence of end-stage renal disease (ESRD) in the world. For patients with ESRD, dialysis is a more common treatment than renal transplantation due to barriers associated with donor shortages and HLA typing. Currently, the cost of dialysis for ESRD in Taiwan takes up ten percent of Taiwan's total national health insurance budget. In addition, the number of new dialysis patients is increasing by 8000 every year. Second only to glomerulonephritis, diabetes is the cause of nearly 30% of all ESRD and 40% of the new dialysis cases. However, it is not known which method of dialysis is best for uremic patients, peritoneal dialysis (PD) or hemodialysis (HD). For most ESRD patients with diabetes, the most important concerns should be the various metabolic consequences and vascular or neuron complications. Hence, in this literature review, we compare the advantage and disadvantages of PD and HD for diabetic patients and discuss the potential problems these patients may encounter with each option. We propose a decision-making flow chart regarding the choice of renal replacement therapy for diabetic patients in Taiwan based on physical condition, diet compliance, glycemic and blood pressure controls, infection risk, macrovascular diseases, impairment of nutrition or lipid metabolism and residual renal function.
