Over the past decades, the impact of dialysis modality on the survival of patients with end-stage renal disease remains controversial. These conflicting results may be caused by the differences in countries and attributed to methodologic differences, such as selection bias, the use of prevalence rate or incidence rate and the degrees of case-mix adjustment (the change of modalities, shifting from peritoneal dialysis (PD) to hemodialysis (HD) and vice versa). Nevertheless, it seems to be generally consensus that the risk of death for PD is lower in the first two years of dialysis compared with that for HD.

　　Diabetes mellitus (DM) has been considered to be one of the most important risk factors of death for diabetic ESRD patients probably due to a high prevalence of cardiovascular diseases in these patients. Glucose and its products such as glucose degeneration products (GDPs) and advanced glycation end products (AGEs) may contribute and accelerate microvascular and macrovascular diseases in diabetic patients. Although alterative osmotic agents such as amino acids and polyglucose (icodextrin) solutions are recently introduced, glucose is still widely used as the main osmotic component in PD dialysate. The impact of glucose in diabetic PD is discussed in this lecture. In addition, whether PD is an acceptable initial modality and the advantages and disadvantages of PD in diabetic ESRD patients are also discussed in this lecture.