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  • Review Article
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Peritoneal dialysis—current status and future challenges

Nature Reviews Nephrology volume 9, pages 399–408 (2013)Cite this article

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Abstract

Peritoneal dialysis is now a well established, mature treatment modality for advanced chronic kidney disease. The medium term (at least 5 year) survival of patients on peritoneal dialysis is currently equivalent to that of those on haemodialysis, and is particularly good in patients who are new to renal replacement therapy and have less comorbidity. Nevertheless the modality needs to keep pace with the constantly evolving challenges associated with the provision and delivery of health care. These challenges, which are gradually converging at a global level, include ageing of the population, multimorbidity of patients, containment of cost, increasing self care and environmental issues. In this context, peritoneal dialysis faces particular challenges that include multiple barriers to the therapy and unsatisfactory and poorly defined technique survival as well as limitations relating to intrinsic aspects of the therapy, such as peritoneal membrane longevity and hypoalbuminaemia. To move the therapy forward and favourably influence health-care policy, the peritoneal dialysis community needs to integrate their research effort more effectively by undertaking clinically meaningful studies—with a strong focus on technique survival—that are supported by multidisciplinary expertise in patient-centred outcomes, study design and analysis.

Key Points

  • The short-to-medium-term survival outcomes of peritoneal dialysis and haemodialysis are now equivalent

  • Peritoneal dialysis can enable patient autonomy and reduce the cost of therapy

  • Currently, peritoneal dialysis is particularly suited to planned dialysis of younger and/or less comorbid patients

  • The main challenges faced by peritoneal dialysis relate to those of an ageing, increasingly multimorbid dialysis population and include barriers to self care, obesity, frailty and hypoalbuminaemia

  • Reducing technique failure should be a major objective of peritoneal dialysis research

  • More integrated, collaborative research underpinned by appropriate methodological expertise is needed to address these challenges

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Figure 1: Comorbidity and multimorbidity.
Figure 2: Barriers to access to peritoneal dialysis.
Figure 3: Integration of peritoneal dialysis research.

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Acknowledgements

This Review is based on the Karl Nolph Lecture given at the 14th Congress of the International Society of Peritoneal Dialysis, Kuala Lumpur, Malaysia, 10th September 2012.

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  1. Department of Nephrology, University Hospital of North Staffordshire, Newcastle Road, Stoke on Trent, ST4 6QG, Staffordshire, UK

    Simon J. Davies

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The author has received research funding and lecture fees from Baxter Healthcare and Fresenius.

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Davies, S. Peritoneal dialysis—current status and future challenges. Nat Rev Nephrol 9, 399–408 (2013). https://doi.org/10.1038/nrneph.2013.100

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