Is there a role for peritoneal dialysis in remote aboriginal patients with end-stage renal disease in Australia?

Peritoneal dialysis (PD) is often the preferred treatment modality of many Aboriginal patients with end-stage renal disease (ESRD) due to their remote locations and the scarcity of remote satellite haemodialysis units. Infectious complications remain an important cause of morbidity in Aboriginal patients maintained on PD in Australia. Analysis of the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) has revealed that Aboriginal PD patients are more likely to have earlier and a higher rate of peritonitis, higher risk of PD technique failure, and higher mortality compared to non-Aboriginal PD patients independent of other factors. However, the finding of Aboriginality as a risk factor for PD-related complications is at least partly attributable to socioeconomic factors, such as poor housing and hygiene. As PD will remain a necessary first-line therapy in this group of isolated and disadvantaged patients, implementing aggressive preventive strategies and targeting modifiable socioeconomic risk factors may reduce morbidity and preserve their independence and way of life.