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      PD and the Future: The Role of PD in the Overall Management of ESRD

      Blood Purification

      S. Karger AG

      Hemodialysis, Dialysis modality distribution, Peritoneal dialysis, Home hemodialysis

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          Given the epidemic growth of ESRD and the high costs of dialysis therapy, there is an urgent need to define the optimal dialysis modality distribution. The factors influencing dialysis modality distribution are complex and not well understood. Based on survey results that have assessed the attitudes of nephrologists in Canada, the USA and the UK, it appears that there is underutilization of both peritoneal dialysis (PD) and home hemodialysis (HD) in these countries. Nephrologists have a positive attitude towards home therapies, and do not appear to be biased against PD. A planned approach to dialysis initiation, with active promotion of PD and home HD as the initial dialysis modality for suitable patients, would be expected to revive usage of home PD and allow for the emergence of daily home HD as a significant and exciting new modality.

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          What is the place of peritoneal dialysis in the integrated treatment of renal failure?

          The role of peritoneal dialysis (PD) in renal replacement therapy (RRT) remains unclear. There are no controlled trials to provide hard evidence of its efficacy. Comparative studies with haemodialysis from different centres and countries have given conflicting results even when allowing for case mix. Data from the United States on patients starting or receiving treatment in the late 1980s suggested a worse prognosis for older patients, particularly diabetics receiving PD as compared to HD. Analysis of the USRDS data base for patients starting in the early 1990s shows an improvement in outcome but with no difference in overall mortality. The Canadian registry has recently published data showing a better survival with PD than with HD in the first two years of RRT. Morbidity is similar with both therapies, although hospitalization is increased with PD. Unfortunately long-term technique survival is not as good with PD. However, PD has certain medical advantages, particularly the maintenance of residual renal function that contributes to solute and fluid removal. It may also postpone the onset of amyloidosis. Patients transplanted after previous PD have a decreased risk of early acute renal failure and equally good long-term results when compared to those patients who were on HD before transplantation. The quality of life is as good with PD as with center HD, and there are social advantages to PD including an increased chance of employment, more flexible holidays and avoidance of thrice weekly travel to a dialysis center. PD also has logistical advantages and can be utilized by the majority of new patients. We therefore conclude that PD has potential advantages early in the course of RRT, and should therefore be offered as a first option to all suitable new patients. Whether PD has a major or minor role in later years (> 5) remains unclear.

            Author and article information

            Blood Purif
            Blood Purification
            S. Karger AG
            22 January 2003
            : 21
            : 1
            : 24-28
            Division of Nephrology and Dialysis, Humber River Regional Hospital, Weston, Ont., Canada
            67853 Blood Purif 2003;21:24–28
            © 2003 S. Karger AG, Basel

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            Page count
            Figures: 3, Tables: 1, References: 19, Pages: 5
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/67853


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