[Improving the outcome of peritoneal dialysis in the long term: is it possible?].
Improving the results of peritoneal dialysis (PD) over time means reducing both the technique's drop out (TDO) and mortality rates. The PD mortality rate has diminished over the years, due to greater experience in using the technique and the reduction in mortality due to peritonitis making it comparable with the hemodialysis (HD) mortality rate. Moreover, improved control of the hydrosaline balance through the use of ambulatory peritoneal dialysis (APD) and icodextrin could further improve the survival rate in the future. The adequacy targets needed to reduce the mortality rate still appear to be debatable, as their importance seems conditioned by the presence of RRF and comorbidity. The TDO is higher in PD than in HD because PD is a self-administered treatment that uses a biological membrane as a filter. The most frequent causes of TDO are peritonitis (30-40%), dialytic inadequacy (11-27%), and subsequent inability and/or choice (10-32%). Peritonitis is the cause that has seen the greatest reduction over time due to the introduction of the Y-Set, but a further reduction could result from the prevention of ESI, and from improvements in the patient selection procedure designed to identify both clinical and psycho-social disposition peritonitis risk factors. Among the causes of TDO due to dialytic inadequacy, insufficient ultrafiltration (UF) could benefit from the diffusion of APD and icodextrin, while insufficient depuration could be reduced by new targets and optimization of the prescription. Finally, TDO due to social causes could be reduced by the use of APD, care support and appropriate patient selection.
Viglino
G
G
S.O.C. Nefrologia e Dialisi, Ospedale San Lazzaro, Via Pierino Belli 26, CAP 12051 Alba (CN), Italy. gviglino@asl18.it
Neri
L
L
D006801:Humans; D010530:Peritoneal Dialysis / Q000401:mortality / Q000592:standards*; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome