Home peritoneal dialysis. A major advance in promoting home dialysis

The institution of a home peritoneal dialysis program has allowed us to increase the number of patients with end-stage renal failure entering our home dialysis program from 42.5% to 67.5% of the total population. This represents a 56.5% increase over the rate achieved by home hemodialysis alone. Twenty-four percent of the home peritoneal dialysis patients could have managed home hemodialysis, but 38 could not and this represents 48% of the total patients who entered our home dialysis program, for the period of the study. These patients would have required institutional dialysis which would not have been practical for 52.6% of them because of the distance they live from Toronto. The results of home peritoneal dialysis have compared favorably with home hemodialysis in the 2 concurrent but unmatched series in respect of training time, failure rate, need for in-hospital back-up and patient survival. A long-term study of matched patients randomized to either treatment group such as that described by Blumenkrantz will finally answer the question as to how valid is our contention that peritoneal dialysis compares favourably to hemodialysis for the treatment of end-stage renal failure.