Peritoneal dialysis in the next millennium

The main thrust of research will be the prevention of renal disease and its progression to the end-stage state (ESRD); such efforts will reduce or even reverse the present epidemic of ESRD by the middle of the 21(st) Century. In the meantime, the number of ESRD patients will continue to increase and, unless xenotransplantation and cloning of one's own kidneys using stem cells will provide an alternative, the various modes of dialysis will continue to be the principle treatment for an increasing numbers of ESRD patients. Peritoneal dialysis (PD) has achieved success at certain salient points and, to advance further, the next generation of nephrologists will have to build on these. They include the following: PD is the treatment of choice for children; it has low rates of peritonitis; it has similar (or in some countries, better) survival rates than hemodialysis; it has lower costs; it has adequate clearances through the introduction of automated PD; and it is an effective treatment for those awaiting a kidney transplant. This report presents the authors' views concerning the areas in which PD will improve in the future. These include (1) a reduction in technique failure rates that will allow us to maintain a larger number of patients on PD for 10 years or more; (2) prevention of long-term changes of the peritoneal membrane through the use of more "friendly" solutions; (3) prevention of malnutrition; (4) the development of better peritoneal access devices; and (5) the increased use of PD as the treatment of first choice for most ESRD patients.