Chapter 3: Peritoneal Dialysis (PD)

The choices between dialysis modalities are remarkably varied around the globe influenced by team skills, cooperation between specialties, socioeconomic, governments mandate to mention a few⁶.  While PD is the prevalent dialysis mode in about 12 % in the United States, 11% in Italy, and 3 % in Japan, it is almost 50% in Hong Kong by government mandate. Factors influencing dialysis modality selection include patient desire, lifestyle, education, and most of all, comorbidities. Team skills, interactions and cooperation between specialties are crucial²³.

Selection of the appropriate dialysis access is a key component in maximizing ideal outcomes. All things considered, renal transplantation is the bets replacement of the dialysis machine. However, the proportion of patients on dialysis transplants is low (less than 3% / year) because of lack of qualification mostly related to multiple co-morbidities. Thus, most patients with ESRD depend upon various dialysis modalities for sustaining life. The algorithm and strategies outline decision-making processes based on many multilayered factors⁷. The intention is to have universal applications driven by the spirit of the mission statement of “Doing Things the Right Way”².  Philosophically, this approach implies that while striving for the best practice option for each patient, the actual treatment modality may be quite different depending on a complex set of circumstances.

Factors favoring PD include lack of vasculature suitable for native vein AVF.  Other medical factors include heparin intolerance. The well-informed patient and family will opt for PD in 30-50 % of cases. PD provides more personal freedom and autonomy, as it is performed by the patient at home. Patients can remain in the workforce and travel, as dialysis can be performed during nighttime. PD is less costly to society, a kidney transplant while on PD has less early dysfunction, there are no needle punctures, and few blood borne infections associated with PD.

Chapter content coming soon.