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In-Depth Review
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Peritoneal Dialysis First: Rationale

Kunal Chaudhary, Harbaksh Sangha and Ramesh Khanna
CJASN February 2011, 6 (2) 447-456; DOI: https://doi.org/10.2215/CJN.07920910
Kunal Chaudhary
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Harbaksh Sangha
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Ramesh Khanna
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Summary

The use of peritoneal dialysis (PD) has become wide spread since the introduction of continuous ambulatory PD more than 25 years ago. Over this time, many advances have been made and PD is an alternative to hemodialysis (HD), with excellent comparable survival, lower cost, and improved quality of life. The percentage of prevalent PD patients in the United States is approximately 7%, which is significantly lower compared with the 15% PD prevalence from the mid-1980s. Despite comparable survival of HD and PD and improved PD technique survival over the last few years, the percentage of patients performing PD in the United States has declined. The increased numbers of in-center HD units, physician comfort with the modality, perceived superiority of HD, and reimbursement incentives have all contributed to the underutilization of PD. In addition to a higher transplantation rate among patients treated with PD in the United States, an important reason for the low PD prevalence is the transfer to HD. There are various reasons for the transfer (e.g., episodes of peritonitis, membrane failure, patient fatigue, etc.). This review discusses the various factors that contribute to PD underutilization and the rationale and strategies to implement “PD first” and how to maintain it. The PD first concept implies that when feasible, PD should be offered as the first dialysis modality. This concept of PD first and HD second must not be seen as a competition between therapies, but rather that they are complementary, keeping in mind the long-term goals for the patient.

  • Copyright © 2011 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 6 (2)
Clinical Journal of the American Society of Nephrology
Vol. 6, Issue 2
1 Feb 2011
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Peritoneal Dialysis First: Rationale
Kunal Chaudhary, Harbaksh Sangha, Ramesh Khanna
CJASN Feb 2011, 6 (2) 447-456; DOI: 10.2215/CJN.07920910

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Peritoneal Dialysis First: Rationale
Kunal Chaudhary, Harbaksh Sangha, Ramesh Khanna
CJASN Feb 2011, 6 (2) 447-456; DOI: 10.2215/CJN.07920910
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    • Summary
    • Introduction
    • Why PD First?
    • Reasons for Transfer to HD and Prevention Strategies
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More in this TOC Section

  • SGLT2 Inhibition in the Diabetic Kidney—From Mechanisms to Clinical Outcome
  • Recognition and Management of Resistant Hypertension
  • Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies
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  • Prevalence-Based Targets Underestimate Home Dialysis Program Activity and Requirements for Growth
  • Striving to Achieve an Integrated Home Dialysis System: A Report from the Ontario Renal Network Home Dialysis Attrition Task Force
  • Feasibility of Urgent-Start Peritoneal Dialysis in Older Patients with End-Stage Renal Disease: A Single-Center Experience
  • Racial Differences in Home Dialysis Utilization and Outcomes in Canada
  • Outcomes of Simultaneous Peritoneal Dialysis and Arteriovenous Fistula Placement in End-Stage Renal Disease Patients
  • Characteristics and Clinical Outcomes of End-Stage Renal Disease Patients on Peritoneal Dialysis for Over 15 Years: A Single-Center Experience
  • Evaluation of a 12-Month Pilot of Long-Term and Temporary Assisted Peritoneal Dialysis
  • Home Dialysis Utilization Among Racial and Ethnic Minorities in the United States at the National, Regional, and State Level
  • Predictors of Transfer to Home Hemodialysis after Peritoneal Dialysis Completion
  • A Global Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An Opinion
  • Patient-Centered Care: An Opportunity to Accomplish the "Three Aims" of the National Quality Strategy in the Medicare ESRD Program
  • Suramin Inhibits the Development and Progression of Peritoneal Fibrosis
  • Liposome-supported peritoneal dialysis for detoxification of drugs and endogenous metabolites
  • Growing a Peritoneal Dialysis Program From 2 to 30 Patients in 2 Years
  • Patient Education and Care for Peritoneal Dialysis Catheter Placement: A Quality Improvement Study
  • Effects of a Pre-dialysis Patient Education Program on the Relative Frequencies of Dialysis Modalities
  • Determinants of Peritoneal Dialysis Technique Failure in Incident US Patients
  • Is Assisted Peritoneal Dialysis Associated with Technique Survival When Competing Events Are Considered?
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