Long term peritoneal dialysis--is it a reality?

The use of peritoneal dialysis (PD) has increased dramatically over the last two decades since the introduction of continuous ambulatory peritoneal dialysis (CAPD). With this has also been the improvement in outcomes. In the medium term (up to five years), there is no difference in patient survival when CAPD is compared with hemodialysis (HD); PD technique survival is also improving, though is somewhat less than on HD. Problem areas for PD appear to be peritoneal membrane related changes, residual function, and peritonitis and these would need to be impacted on to improve outcome and long-term survival on PD. Current data would suggest that not many patients continue on peritoneal dialysis beyond ten years. However there are developments which show promise and are likely to enhance the outcome. It is possible to maximise renal replacement therapy by using peritoneal dialysis as the initial therapy. Arguments that favour this are discussed.