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International Journal of Nephrology
Volume 2011, Article ID 239515, 5 pages
Review Article

In Peritoneal Dialysis, Is There Sufficient Evidence to Make “PD First” Therapy?

1Division of Nephrology, Department of Internal Medicine, University of Missouri, Columbia, Mo 65212, USA
2Division of Nephrology, Harry S Truman Veterans's Hospital, Columbia, Mo 65201, USA

Received 19 January 2011; Revised 6 April 2011; Accepted 20 April 2011

Academic Editor: Hulya Taskapan

Copyright © 2011 Pranav Dalal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Since its introduction more than 3 decades ago, the use of peritoneal dialysis (PD) has increased greatly due to its simplicity, convenience, and low cost. Advances in technique, antibiotic prophylaxis, and the introduction of newer solutions have improved survival, quality of life, and reduced rate of complications with PD. In Hong Kong, approximately 80% end-stage renal disease (ESRD) patients perform PD; in others, that is, Canada, Australia, and New Zealand, 20%–30% patients use PD. However, in the United States, the annual rate of prevalent patients receiving PD has reduced to 8% from its peak of 15% in mid-1980s. PD as the initial modality is being offered to far less patients than hemodialysis (HD), resulting in the current annual incidence rate of less than 10% in USA. There are many reasons preventing the PD first initiative including the increased numbers of in-center hemodialysis units, physician comfort with the modality, perceived superiority of HD, risk of peritonitis, achieving adequate clearances, and reimbursement incentives to providers. Patient fatigue, membrane failure, and catheter problems are other reasons which discourage PD utilization. In this paper, we discuss the available evidence and provide rationale to support PD as the initial renal replacement modality for ESRD patients.