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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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    Table 1.

    Potential causes of underutilization and transfer to HD

    Modality related
        infections
            peritonitis
            tunnel infection, exit-site infections
        inadequate dialysis
            unable to meet clearance targets (Kt/V or creatinine clearance)
        ultrafiltration failure
            inability to achieve dry weight
            persistent volume overload
            mechanical problems
        catheter problems
            infections
            mechanical complications
    System related
        lack of infrastructure
        lack of patient modality education/training
        transfer to a facility where PD is unavailable
        center effect
        provider expertise
        physician reimbursement
        ownership of dialysis facility
    Patient related
        patient burnout
        social reasons, family, age, occupation, etc.
        geography: distance to travel
        loss of RRF
        malnutrition/excess protein loss
        diabetic complications: severe neuropathy, blindness
        abdominal surgeries or development of hernia
        respiratory problems, chronic cough
        stroke or severe illness limiting manual dexterity
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    Table 2.

    Strategies to maintain PD

    Modality related
        peritonitis prophylaxis
        membrane preservation: use of glucose polymers/ACE inhibitors
        adjust dialysis prescription according to RRF
        correction of catheter malfunction
    System related
        better infrastructure to support PD
        patient education/training
        physician education
        incentives to physicians, dialysis centers
        redirecting resources
    Patient related
        social support
        psychological counseling (as needed)
        assisted PD
    • ACE, angiotensin converting enzyme.

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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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  • Article
    • Summary
    • Introduction
    • Why PD First?
    • Reasons for Transfer to HD and Prevention Strategies
    • Conclusions
    • Disclosures
    • Footnotes
    • References
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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
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  • 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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