The future of peritoneal dialysis.

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Public Health

Background:

• Peritoneal dialysis (PD) is a leading home dialysis modality with established 5-year outcomes and cost-effectiveness.
• Despite benefits, PD faces challenges including physical constraints and the need for further harm-reduction technologies.

Purpose of the Study:

• To identify key areas for future improvement in peritoneal dialysis.
• To address the significant challenge of inequitable access to PD globally and within Europe.
• To explore transformative solutions for enhancing PD's role in worldwide dialysis provision.

Main Methods:

• Review of existing PD outcomes and cost-utility analyses.
• Analysis of factors contributing to PD access variation across Europe and globally.
• Discussion of policy initiatives and technological advancements for PD.

Main Results:

• PD demonstrates favorable outcomes and cost benefits but requires focus on residual kidney function preservation, symptom management, and inflammation suppression.
• Significant inequities in PD uptake exist due to economic, attitudinal, organizational, and educational factors.
• High cost of PD fluid and lack of universal healthcare coverage hinder global PD use.

Conclusions:

• Future PD improvements should prioritize interventions applicable to the broader dialysis population and address access disparities.
• A collective, multistakeholder effort is crucial to overcome barriers to PD access.
• Point-of-care dialysis fluid generation presents a transformative solution for equitable global PD access and environmental sustainability.