Importance of residual renal function and peritoneal dialysis in anuric patients

Residual renal function (RRF) impacts on patient survival and quality of life of dialysis patients. Its longer preservation is a major advantage of peritoneal dialysis (PD) and should be also a target of adequacy, beyond Kt/V. Anuric patients no longer benefit from such PD advantage, depending only on dialysis schedule to achieve adequate small solute and volume control. This challenge can be successfully dealt with by using automated PD, icodextrine, low-glucose degradation products and individualized PD profiles. There is evidence that PD advances allow nowadays satisfactory patient survival while keeping the benefits of home dialysis and preserving vascular network. An integrated care plan should consider both medical indications and patient preference aiming for the longer total patient survival, even if transfer to HD might be later needed as part of individualized renal replacement strategy.