title: Where we come from and where we are going in terms of peritoneal dialysis: identifying barriers and strategies for the future.
abstract: Despite the 40 years history, the comparable survival of Hemodialysis and Peritoneal Dialysis (PD), and the improved PD technique survival, the percentage of patients performing PD is low. After a short history review and data description, we analyze the many non-medical factors (&ldquo;the vicious circle&rdquo;) that contribute to the underutilization of PD: inadequate medical training, lack of infrastructures, small PD units, inadequate patient education for choice of dialysis modality, lack of multidisciplinary end-stage renal disease units, the proliferation of hemodialysis centers, or the trends in government reimbursement. Several of these factors are modifiable, and we propose future strategies to increase the use of PD.
authors.forename: M Mercedes
authors.initials: MM
authors.lastname: Moreiras-Plaza
mesh_terms: D003362:Cost-Benefit Analysis; D005544:Forecasting; D006282:Health Personnel / Q000193:education; D006757:Hospital Units / Q000191:economics / Q000600:supply & distribution; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D009398:Nephrology / Q000193:education; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D013030:Spain; D014481:United States; D016526:Workload