Diabetic nephropathy is highly correlated with the occurrence of other complications of type 1 diabetes (T1D) and type 2 diabetes (T2D) mellitus; for example, hypertension with cardiovascular disease (CVD) being the most frequent cause of death in patients with end-stage renal disease and undergoing renal dialysis. Hyperglycemia and insulin resistance (IR) are responsible for the micro- and macrovascular complications of diabetes through different mechanisms. In particular, IR plays a key role in the etiology of atherosclerosis in both diabetic and non-diabetic patients. IR – exacerbated by organ-level selectivity – is more important than glycemic control per se in determining cardiovascular outcomes. This may be exacerbated by the fact that IR is organ and pathway specific due to the only selective loss of sensitivity to insulin action of specific pathways/processes. Therefore, it is counterintuitive that the use of peritoneal dialysis (PD) in (frequently) diabetic renal disease patients should involve their exposure to high daily doses of glucose peritoneally. In view of the controversy about the causal association between glucose load and CVD in PD patients, we discuss the role that selective IR may play in the progression of CVD in diabetic renal end-stage patients. In discussing these associations, we propose that reducing glucose exposure in PD solutions may be beneficial especially if coupled with strategies that address IR directly, and the avoidance of excessive use of insulin treatment in T2D.

糖尿病肾病与1型糖尿病（T1D）和2型糖尿病（T2D）其他并发症的发生高度相关；例如，高血压伴心血管疾病 (CVD) 是终末期肾病和接受肾透析患者最常见的死亡原因。高血糖和胰岛素抵抗 (IR) 通过不同的机制导致糖尿病的微血管和大血管并发症。特别是，IR 在糖尿病和非糖尿病患者的动脉粥样硬化病因学中起关键作用。IR——由于器官水平的选择性而加剧——比血糖控制本身更重要在确定心血管结果。由于对特定途径/过程的胰岛素作用的敏感性唯一选择性丧失，IR 是器官和途径特异性的事实可能会加剧这种情况。因此，在（经常）糖尿病肾病患者中使用腹膜透析（PD）应该涉及他们在腹膜中暴露于每日高剂量的葡萄糖，这是违反直觉的。鉴于关于 PD 患者葡萄糖负荷与 CVD 之间因果关系的争议，我们讨论了选择性 IR 在糖尿病肾终末期患者 CVD 进展中可能发挥的作用。在讨论这些关联时，我们建议减少 PD 溶液中的葡萄糖暴露可能是有益的，特别是如果结合直接解决 IR 的策略，以及避免在 T2D 中过度使用胰岛素治疗。