Peritoneal dialysis: an underutilized modality

Curr Opin Nephrol Hypertens. 2010 Nov;19(6):573-7. doi: 10.1097/MNH.0b013e32833d67a3.

Abstract

Purpose of review: There have been differential changes in outcomes of patients treated with in-center hemodialysis and peritoneal dialysis. In light of these changes, providers and practices should reevaluate the utilization of peritoneal dialysis.

Recent findings: Accumulating evidence confirms that the present distribution of dialysis modality in the United States does not reflect patient choice. Furthermore, in most recent cohorts, the 5-year adjusted survival of patients treated with hemodialysis and peritoneal dialysis is remarkably similar (35 and 33% respectively). Similar results have been reported from Canada, Australia, and New Zealand. Moreover, health-related quality of life of peritoneal dialysis patients are no different from that reported by those treated with nocturnal hemodialysis. Finally, an expansion of use of peritoneal dialysis for the treatment of end-stage renal disease makes economic sense for the taxpayers - the payors for dialysis services.

Summary: The improvement in outcomes of peritoneal dialysis patients makes a compelling argument for the expansion of the use of the therapy for the treatment of end-stage renal disease in the United States. We think that 20-40% of patients can be treated with peritoneal dialysis. However, any expansion in use should be done gradually and should include training healthcare providers while continuously monitoring patient outcomes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cost-Benefit Analysis
  • Developing Countries
  • Health Care Costs
  • Humans
  • Kidney Failure, Chronic / economics
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / psychology
  • Kidney Failure, Chronic / therapy*
  • Outcome and Process Assessment, Health Care*
  • Peritoneal Dialysis / adverse effects
  • Peritoneal Dialysis / economics
  • Peritoneal Dialysis / mortality
  • Peritoneal Dialysis / statistics & numerical data*
  • Quality of Life
  • Renal Dialysis / adverse effects
  • Renal Dialysis / economics
  • Renal Dialysis / mortality
  • Renal Dialysis / statistics & numerical data*
  • Treatment Outcome
  • United States