Health-care economics and peritoneal dialysis

There is no question that the next decade will see an enormous growth in the worldwide dialysis population. Increasingly, old and sick patients will be accepted on dialysis, and the worldwide dialysis population characteristics will approach those now seen in the U.S. In addition, recent attention in the U.S. and elsewhere on the mortality of dialysis patients is already resulting in an improvement in this regard, further expanding the future dialysis population. PD will continue to increase in use, particularly with continued worldwide economic pressures on dialysis providers. To the extent that the efficacy of this treatment can be improved, without eroding its economic benefits over HD, it should fare well in the future. If, on the other hand, expensive "adjustments" in the practice of PD are needed to assure reasonable medical outcomes, PD will likely fade in popularity. The challenge to those involved in PD--clinicians, scientists, companies--is to develop a PD system that optimizes patient medical and psychosocial outcomes, and minimizes costs. If this cannot be accomplished, PD is likely to be replaced by new dialytic systems in the future (e.g., daily, slow, home hemodialysis) that can succeed in these areas.