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Peritoneal dialysis should not be the first choice for renal replacement therapy in the elderly

Mary Mallappallil1, Ankita Patel, Eli A Friedman

  • 1Renal Disease Division, State University of New York, Downstate Medical Center, Brooklyn, New York 11203, USA.

Seminars in Dialysis
|October 20, 2012
PubMed

Insights

Peritoneal dialysis (PD) and in-center hemodialysis (HD) show similar long-term outcomes. PD may benefit younger, nondiabetic patients initially, but it is not ideal for elderly diabetic patients on dialysis.

Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Dialysis Modalities

Background:

  • In-center hemodialysis (HD) is the predominant form of renal replacement therapy in the United States.
  • Peritoneal dialysis (PD) offers an alternative treatment modality for end-stage renal disease.
  • Patient selection and long-term outcomes comparing PD and HD require ongoing evaluation.

Purpose of the Study:

  • To compare the long-term outcomes of peritoneal dialysis (PD) versus in-center hemodialysis (HD).
  • To identify patient subgroups that may benefit from specific dialysis modalities.

Main Methods:

  • Systematic review of existing literature comparing PD and in-center HD.
  • Analysis of patient demographics, comorbidities, and long-term survival data.

Main Results:

  • No significant substantive differences in long-term outcomes were documented between PD and in-center HD.
  • A potential slight advantage for PD was observed in younger, nondiabetic patients during the early stages of renal replacement therapy.
  • PD was found to be disadvantageous for elderly diabetic patients, a significant portion of the US dialysis population.

Conclusions:

  • Current evidence does not support significant long-term outcome differences between PD and in-center HD.
  • Treatment decisions should consider patient-specific factors, including age, diabetic status, and treatment phase.
  • PD may not be the optimal choice for the growing population of elderly diabetic patients requiring dialysis.

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