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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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          Abstract

          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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          Most cited references 1

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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.
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            Author and article information

            Journal
            BPU
            Blood Purif
            10.1159/issn.0253-5068
            Blood Purification
            S. Karger AG
            978-3-8055-7535-5
            978-3-318-00939-2
            0253-5068
            1421-9735
            2003
            2003
            22 January 2003
            : 21
            : 1
            : 24-28
            Affiliations
            Division of Nephrology and Dialysis, Humber River Regional Hospital, Weston, Ont., Canada
            Article
            67853 Blood Purif 2003;21:24–28
            10.1159/000067853
            12566657
            © 2003 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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