Cost benefits of peritoneal dialysis in specific groups of patients

The cost benefit of peritoneal dialysis (PD) is reflected in generally lower expenditure than in-center hemodialysis while clinical advantages of home therapy are guaranteed. PD offers similar patient survival in comparison with hemodialysis, and opportunities of better adequacy, beyond Kt/V, including continuous removal of uremic toxins, residual renal function protection, nutritional intraperitoneal support, and life satisfaction. Advances on the modality including the use of icodextrine, automated PD, low-glucose degradation products, new solutions and individualized schedules promise to improve the prognosis of risk patients under dialysis such as diabetics and patients with congestive heart failure, the elderly, the fast transporters or the anuric. Patients deserve an individualized prescription taking into account their lifestyle and therapy options in an integrated care plan. PD after renal transplantation failure is an emerging group of PD patients with need for specific protocols, while PD in the acute setting can also be considered in specific situations.