In 2008, an estimated 1.77 million patients worldwide received dialysis. Of these patients, 1.58 million were treated with hemodialysis and approximately 190,000 received peritoneal dialyisis. In a global comparison of treatment methods for renal failure, therefore, hemodialysis clearly dominates. In this Review, we compare the epidemiology of peritoneal dialysis with that of hemodialysis and describe some of the major differences in the global utilization of the two dialysis modalities. These differences can largely be explained by a number of nonmedical, mainly economic factors, but also by educational and psychological factors. To reverse the current trends, the implementation of suitable reimbursement strategies for peritoneal dialysis is needed as well as increased investment in the training of young nephrology fellows and in education programs for patients and other non-nephrological health-care providers. To achieve these goals, academic and nonacademic training centers, which often consider peritoneal dialysis to be a low-level priority, must invest in research and training related to peritoneal dialysis.