[French 2008 guidelines on peritoneal dialysis: indications and non-indications]

The new French guidelines on Peritoneal Dialysis (PD) were published in october 2008 by the "Haute Autorité de Santé (HAS)". The field of these guidelines concerned the choice between PD and Hemodialysis (HD), on a strict medical point of view. This paper summarizes the main French PD guidelines, highlighting the new insights compared to previous guidelines. For the first time, guidelines described 5 clinical situations requiring the choice between PD or HD : 1) criteria for choosing PD in a new dialysis patient ; 2) criteria for switching a patient from PD to HD ; 3) criteria for switching a patient from HD to PD ; 4) PD or HD before kidney transplantation ; 5) PD or HD after graft failure. For a new dialysis patient, PD is recommended, more than HD, for cirrhotic patients with ascites, kidney failure due to cholesterol embolism, difficulties for HD-vascular access. PD is not recommended in only a few cases : morbid obesity (BMI>45 kg /m(2)), irreparable abdominal hernias. It is recommended to switch from PD to HD, patients with more than 3 peritonitis/year, due to digestive bacteria ; weight gain > 15 % per year ; triglycerid serum level > 10 g/l ; loss of peritoneal efficiency. It is recommended to switch from HD to PD patients with vascular access failure ; hemodynamic instability during HD sessions ; severe congestive heart failure. PD or HD can be indistinctly used before kidney or combined pancreas-kidney graft. These new French guidelines are more complete and more accurate than the previous French or international guidelines.