The future of peritoneal dialysis: PD in 2010 and beyond

Peritoneal dialysis (PD) has been used to treat patients with stage V chronic kidney disease since 1976. The number of patients on PD varies from country to country and was only about 8% of the U.S. population by the end of 2009, despite the fact that medical outcome data would seem to favor more utilization of PD. For instance, data from the United States Renal Data Systems suggests that the relative risk of death for patients on PD versus center hemodialysis (CHD) has been improving, tending to favor those on PD for longer periods of time. In addition, infectious complications have been markedly reduced. In these economic times it is important to note that PD is less costly than CHD, which has influenced anticipated changes in government reimbursement—such as the bundling of dialysis‐related services in the U.S. These facts should stimulate a renewed interest in home therapies, especially PD. However, for this therapy to be more successful, the PD community must better educate its members (in the U.S., PD education during fellowship is often lacking, many current PD units are small and the number of well‐trained PD nurses may not be able to optimally meet an increase in demand). Peritoneal dialysis will face many challenges, such as: frequent hemodialysis schedules that may be more and more appealing to patients and providers; the aging of the end‐stage renal disease (ESRD) population; regulatory issues; lack of infrastructure at some units; and problems related to long‐term use of PD. This article will review some of these challenges.