Changes in the dose of peritoneal dialysis: have these independently affected outcomes?

Over the past decade, there has been a sustained improvement in mortality rates for peritoneal dialysis (PD) patients in the United States and Canada. Although patients with diabetes continue to have higher mortality rates than those without diabetes, the observed improvement in PD patient survival rates has been even more marked among patients with diabetes. There has been an impressive improvement in death rates in older and younger PD patients with diabetes in both the United States and Canada. The observed improvement in mortality rates in US and Canadian PD patients preceded concerns about dialysis adequacy and efforts to increase the dose of PD. Thus, it is too early to see the effect of attention to dialysis dose reflected in published data from these registries. The ongoing improvement in mortality is an encouraging trend for dialysis practitioners and patients because even further improvement can be expected as the prescription of adequate doses of PD become more widespread.