Peritoneal dialysis: an underutilized modality.
OBJECTIVE
There have been differential changes in outcomes of patients treated with in-center hemodialysis and peritoneal dialysis. In light of these changes, providers and practices should reevaluate the utilization of peritoneal dialysis.


RESULTS
Accumulating evidence confirms that the present distribution of dialysis modality in the United States does not reflect patient choice. Furthermore, in most recent cohorts, the 5-year adjusted survival of patients treated with hemodialysis and peritoneal dialysis is remarkably similar (35 and 33% respectively). Similar results have been reported from Canada, Australia, and New Zealand. Moreover, health-related quality of life of peritoneal dialysis patients are no different from that reported by those treated with nocturnal hemodialysis. Finally, an expansion of use of peritoneal dialysis for the treatment of end-stage renal disease makes economic sense for the taxpayers - the payors for dialysis services.


CONCLUSIONS
The improvement in outcomes of peritoneal dialysis patients makes a compelling argument for the expansion of the use of the therapy for the treatment of end-stage renal disease in the United States. We think that 20-40% of patients can be treated with peritoneal dialysis. However, any expansion in use should be done gradually and should include training healthcare providers while continuously monitoring patient outcomes.
Jiwakanon
Sirin
S
Los Angeles Biomedical Research Institute, Torrance, California, USA.
Chiu
Yi-Wen
YW
Kalantar-Zadeh
Kamyar
K
Mehrotra
Rajnish
R
D003362:Cost-Benefit Analysis; D003906:Developing Countries; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States