Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Peritoneal dialysis—current status and future challenges

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

Subjects

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

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

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

References

  1. Jain, A. K., Blake, P., Cordy, P. & Garg, A. X. Global trends in rates of peritoneal dialysis. J. Am. Soc. Nephrol. 23, 533–544 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wang, H. et al. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2071–2094 (2012).

    Article  PubMed  Google Scholar 

  3. Gapminder Foundation. Gapminder world. Gapminder for a fact based world [online], (2013).

  4. Christensen, K., Doblhammer, G., Rau, R. & Vaupel, J. W. Ageing populations: the challenges ahead. Lancet 374, 1196–1208 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Murray, C. J. et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2197–2223 (2012).

    Article  PubMed  Google Scholar 

  6. Meguid El Nahas, A. & Bello, A. K. Chronic kidney disease: the global challenge. Lancet 365, 331–340 (2005).

    Article  CAS  PubMed  Google Scholar 

  7. Williams, M. E., Sandeep, J. & Catic, A. Aging and ESRD demographics: consequences for the practice of dialysis. Semin. Dial. 25, 617–622 (2012).

    Article  PubMed  Google Scholar 

  8. The Renal Association. UK Renal Registry Reports. UK Renal Registry [online], (2013).

  9. Gersh, B. J., Sliwa, K., Mayosi, B. M. & Yusuf, S. Novel therapeutic concepts: the epidemic of cardiovascular disease in the developing world: global implications. Eur. Heart J. 31, 642–648 (2010).

    Article  PubMed  Google Scholar 

  10. Ekundayo, O. J. et al. Multimorbidity due to diabetes mellitus and chronic kidney disease and outcomes in chronic heart failure. Am. J. Cardiol. 103, 88–92 (2009).

    Article  PubMed  Google Scholar 

  11. Ritchie, C. et al. Effects of diabetes mellitus in patients with heart failure and chronic kidney disease: a propensity-matched study of multimorbidity in chronic heart failure. Int. J. Cardiol. 134, 330–335 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Barnett, K. et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380, 37–43 (2012).

    Article  PubMed  Google Scholar 

  13. Formiga, F. et al. Patterns of comorbidity and multimorbidity in the oldest old: the Octabaix study. Eur. J. Intern. Med. 24, 40–44 (2013).

    Article  PubMed  Google Scholar 

  14. Schäfer, I. et al. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS ONE 5, e15941 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Davies, S. J., Phillips, L., Naish, P. F. & Russell, G. I. Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival. Nephrol. Dial. Transplant. 17, 1085–1089 (2002).

    Article  PubMed  Google Scholar 

  16. van Manen, J. G. et al. How to adjust for comorbidity in survival studies in ESRD patients: a comparison of different indices. Am. J. Kidney Dis. 40, 82–89 (2002).

    Article  PubMed  Google Scholar 

  17. Loeb, D. F., Ghushchyan, V., Huebschmann, A. G., Lobo, I. E. & Bayliss, E. A. Association of treatment modality for depression and burden of comorbid chronic illness in a nationally representative sample in the United States. Gen. Hosp. Psychiatry 34, 588–597 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Noël, P. H., Frueh, B. C., Larme, A. C. & Pugh, J. A. Collaborative care needs and preferences of primary care patients with multimorbidity. Health Expect. 8, 54–63 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Agborsangaya, C. B., Lau, D., Lahtinen, M., Cooke, T. & Johnson, J. A. Health-related quality of life and healthcare utilization in multimorbidity: results of a cross-sectional survey. Qual. Life Res. 22, 791–799 (2013).

    Article  PubMed  Google Scholar 

  20. Stenvinkel, P., Heimbürger, O., Lindholm, B., Kaysen, G. A. & Bergström, J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol. Dial. Transplant. 15, 953–960 (2000).

    Article  CAS  PubMed  Google Scholar 

  21. Cesari, M. et al. Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. Am. J. Clin. Nutr. 83, 1142–1148 (2006).

    Article  CAS  PubMed  Google Scholar 

  22. Organisation for Economic Co-operation and Development. Health at a glance 2011: OECD indicators. OECD [online], (2011).

  23. Abegunde, D. O., Mathers, C. D., Adam, T., Ortegon, M. & Strong, K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 370, 1929–1938 (2007).

    Article  PubMed  Google Scholar 

  24. Shepperd, S., Wee, B. & Straus, S. E. Hospital at home: home-based end of life care. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD009231. http://dx.doi.org/10.1002/14651858.CD009231.

  25. Shepperd, S. et al. Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data. CMAJ 180, 175–182 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  26. Stacey, D. et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD001431. http://dx.doi.org/10.1002/14651858.CD001431.pub3.

  27. James, R. Dialysis and the environment: comparing home and unit based haemodialysis. J. Ren. Care. 33, 119–123 (2007).

    Article  CAS  PubMed  Google Scholar 

  28. The Renal Association. UK Renal Registry 14th Annual Report. UK Renal Registry [online], (2012).

  29. Rubin, H. R. et al. Patient ratings of dialysis care with peritoneal vs haemodialysis. JAMA 291, 697–703 (2004).

    Article  CAS  PubMed  Google Scholar 

  30. Tong, A. et al. The perspectives of adults living with peritoneal dialysis: thematic synthesis of qualitative studies. Am. J. Kidney Dis. http://dx.doi.org/10.1053/j.ajkd.2012.08.045.

  31. Kutner, N. G., Zhang, R., Barnhart, H. & Collins, A. J. Health status and quality of life reported by incident patients after 1 year on haemodialysis or peritoneal dialysis. Nephrol. Dial. Transplant. 20, 2159–2167 (2005).

    Article  PubMed  Google Scholar 

  32. National Institute for Health and Care Excellence. Clinical Guideline 125. Peritoneal dialysis in the treatment of stage 5 chronic kidney disease. National Institute for Health and Care Excellence [online], (2011).

  33. Golper, T. A. et al. Home dialysis in the new USA bundled payment plan: implications and impact. Perit. Dial. Int. 31, 12–16 (2011).

    Article  PubMed  Google Scholar 

  34. Just, P. M. et al. Economic evaluations of dialysis treatment modalities. Health Policy 86, 163–180 (2008).

    Article  PubMed  Google Scholar 

  35. Dhanakijcharoen, P. et al. The “PD First” policy in Thailand: three-years experiences (2008–2011). J. Med. Assoc. Thai. 94 (Suppl. 4), S153–S161 (2011).

    PubMed  Google Scholar 

  36. Duong, U. et al. Glycaemic control and survival in peritoneal dialysis patients with diabetes mellitus. Clin. J. Am. Soc. Nephrol. 6, 1041–1048 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Liao, C. T. et al. Associations of metabolic syndrome and its components with cardiovascular outcomes among non-diabetic patients undergoing maintenance peritoneal dialysis. Nephrol. Dial. Transplant. 26, 4047–4054 (2011).

    Article  PubMed  Google Scholar 

  38. Chen, K. H. et al. Impaired fasting glucose association with mortality in non-diabetic patients on maintenance peritoneal dialysis. Am. J. Med. Sci. 341, 312–317 (2011).

    Article  PubMed  Google Scholar 

  39. Selby, N. M., Fialova, J., Burton, J. O. & McIntyre, C. W. The haemodynamic and metabolic effects of hypertonic-glucose and aminoacidbased peritoneal dialysis fluids. Nephrol. Dial. Transplant. 22, 870–879 (2007).

    Article  CAS  PubMed  Google Scholar 

  40. Little, J. et al. Longitudinal lipid profiles on CAPD: their relationship to weight gain, comorbidity, and dialysis factors. J. Am. Soc. Nephrol. 9, 1931–1939 (1998).

    CAS  PubMed  Google Scholar 

  41. Jialin, W., Yi, Z. & Weijie, Y. Relationship between body mass index and mortality in haemodialysis patients: a meta-analysis. Nephron Clin. Pract. 121, c102–c111 (2012).

    PubMed  Google Scholar 

  42. de Mutsert, R., Grootendorst, D. C., Boeschoten, E. W., Dekker, F. W. & Krediet, R. T. Is obesity associated with a survival advantage in patients starting peritoneal dialysis? Contrib. Nephrol. 163, 124–131 (2009).

    PubMed  Google Scholar 

  43. Stack, A. G., Murthy, B. V. & Molony, D. A. Survival differences between peritoneal dialysis and haemodialysis among “large” ESRD patients in the United States. Kidney Int. 65, 2398–2408 (2004).

    Article  PubMed  Google Scholar 

  44. McDonald, S. P., Collins, J. F. & Johnson, D. W. Obesity is associated with worse peritoneal dialysis outcomes in the Australia and New Zealand patient populations. J. Am. Soc. Nephrol. 11, 2894–2901 (2003).

    Article  Google Scholar 

  45. Vonesh, E. F., Snyder, J. J., Foley, R. N. & Collins, A. J. The differential impact of risk factors on mortality in haemodialysis and peritoneal dialysis. Kidney Int. 66, 2389–2401 (2004).

    Article  PubMed  Google Scholar 

  46. van de Luijtgaarden, M. W. et al. Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in Europe. Nephrol. Dial. Transplant. 26, 2940–2947 (2011).

    Article  PubMed  Google Scholar 

  47. Germing, A. et al. High frequency of diastolic dysfunction in a population-based cohort of elderly women—but poor association with the symptom dyspnea. BMC Geriatr. 11, 71 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Oliver, M. J. et al. Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization. Nephrol. Dial. Transplant. 8, 2737–2744 (2010).

    Article  Google Scholar 

  49. Lambert, M. C., Lage, C. & Kirchgessner, J. Stay.safe. A new PVC free system in long-term CAPD treatment. EDTNA ERCA J. 25, 30–34 (1999).

    Article  CAS  PubMed  Google Scholar 

  50. Voges, M., Faict, D., Lechien, G. & Taminne, M. Stability of drug additives in peritoneal dialysis solutions in a new container. Perit. Dial. Int. 24, 590–595 (2004).

    CAS  PubMed  Google Scholar 

  51. United States Renal Data System. 2009 USRDS Annual Data Report: atlas of chronic kidney disease and end-stage renal disease in the United States. United States Renal Data System [online], (2009).

  52. Kramer, A. et al. ERA–EDTA Registry. An update on renal replacement therapy in Europe: ERA–EDTA Registry data from 1997 to 2006. Nephrol. Dial. Transplant. 24, 557–566 (2009).

    Article  Google Scholar 

  53. Mehrotra, R. et al. Similar outcomes with haemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch. Intern. Med. 171, 110–118 (2011).

    Article  PubMed  Google Scholar 

  54. Yeates, K. et al. Haemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada. Nephrol. Dial. Transplant. 27, 568–575 (2012).

    Article  Google Scholar 

  55. Noordzij, M. & Jager, K. J. Survival comparisons between haemodialysis and peritoneal dialysis. Nephrol. Dial. Transplant. 27, 385–387 (2012).

    Article  Google Scholar 

  56. Bloembergen, W. E., Port, F. K., Mauger, E. A. & Wolfe, R. A. A comparison of mortality between patients treated with haemodialysis and peritoneal dialysis. J. Am. Soc. Nephrol. 6, 177–183 (1995).

    CAS  PubMed  Google Scholar 

  57. Weinhandl, E. D. et al. Propensity-matched mortality comparison of incident haemodialysis and peritoneal dialysis patients. J. Am. Soc. Nephrol. 21, 499–506 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  58. US National Library of Medicine. ClinicalTrials.gov [online], (2011).

  59. Mehrotra, R., Chiu, Y. W., Kalantar-Zadeh, K. & Vonesh, E. The outcomes of continuous ambulatory and automated peritoneal dialysis are similar. Kidney Int. 76, 97–107 (2009).

    Article  PubMed  Google Scholar 

  60. Perl, J. et al. Haemodialysis vascular access modifies the association between dialysis modality and survival. J. Am. Soc. Nephrol. 22, 1113–1121 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  61. Jaar, B. G. et al. Comparing the risk for death with peritoneal dialysis and haemodialysis in a national cohort of patients with chronic kidney disease. Ann. Intern. Med. 143, 174–183 (2005).

    Article  PubMed  Google Scholar 

  62. McDonald, S. P., Marshall, M. R., Johnson, D. W. & Polkinghorne, K. R. Relationship between dialysis modality and mortality. J. Am. Soc. Nephrol. 20, 155–163 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  63. Termorshuizen, F. et al. Haemodialysis and peritoneal dialysis: Comparison of adjusted mortality rates according to the duration of dialysis—analysis of The Netherlands Cooperative Study on the Adequacy of Dialysis 2. J. Am. Soc. Nephrol. 14, 2851–2860 (2003).

    Article  PubMed  Google Scholar 

  64. Lindholm, B. & Davies, S. J. Timing of dialysis initiation and dialysis modality. Nat. Rev. Nephrol. 7, 66–68 (2011).

    Article  PubMed  Google Scholar 

  65. Davies, S. J. Mitigating peritoneal membrane characteristics in modern peritoneal dialysis therapy. Kidney Int. Suppl. 103, S76–S83 (2006).

    Article  CAS  Google Scholar 

  66. Johnson, D. W. et al. Superior survival of high transporters treated with automated versus continuous ambulatory peritoneal dialysis. Nephrol. Dial. Transplant. 25, 1973–1979 (2010).

    Article  PubMed  Google Scholar 

  67. Cho, J. H. et al. Impact of systemic and local peritoneal inflammation on peritoneal solute transport rate in new peritoneal dialysis patients: a 1-year prospective study. Nephrol. Dial. Transplant. 25, 1964–1973 (2010).

    Article  CAS  PubMed  Google Scholar 

  68. Davies, S. J. Overfill or ultrafiltration? We need to be clear. Perit. Dial. Int. 26, 449–451 (2006).

    PubMed  Google Scholar 

  69. Han, S. H., Ahn, S. V., Yun, J. Y., Tranaeus, A. & Han, D. S. Effects of icodextrin on patient survival and technique success in patients undergoing peritoneal dialysis. Nephrol. Dial. Transplant. 27, 2044–2050 (2012).

    Article  CAS  PubMed  Google Scholar 

  70. Qi, H., Xu, C., Yan, H. & Ma, J. Comparison of icodextrin and glucose solutions for long dwell exchange in peritoneal dialysis: a meta-analysis of randomized controlled trials. Perit. Dial. Int. 31, 179–188 (2011).

    Article  CAS  PubMed  Google Scholar 

  71. de Jager, D. J. et al. Cardiovascular and non-cardiovascular mortality among patients starting dialysis. JAMA 302, 1782–1789 (2009).

    Article  CAS  PubMed  Google Scholar 

  72. Jansen, M. A. et al. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int. 62, 1046–1053 (2002).

    Article  PubMed  Google Scholar 

  73. Burton, J. O., Jefferies, H. J., Selby, N. M. & McIntyre, C. W. Haemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin. J. Am. Soc. Nephrol. 4, 1925–1931 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  74. Selby, N. M. & McIntyre, C. W. Peritoneal dialysis is not associated with myocardial stunning. Perit. Dial. Int. 31, 27–33 (2011).

    Article  PubMed  Google Scholar 

  75. Just, P. M. et al. Reimbursement and economic factors influencing dialysis modality choice around the world. Nephrol. Dial. Transplant. 23, 2365–2373 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  76. Vanholder, R. et al. Reimbursement of dialysis: a comparison of seven countries. J. Am. Soc. Nephrol. 23, 1291–1298 (2012).

    Article  PubMed  Google Scholar 

  77. United States Renal Data System. 2012 USRDS Annual Data Report: atlas of chronic kidney disease and end-stage renal disease in the United States. United States Renal Data System [online], (2012).

  78. Castledine, C., Gilg, J., Rogers, C., Ben-Shlomo, Y. & Caskey, F. UK Renal Registry 13th Annual Report (December 2010): Chapter 15: UK renal centre survey results 2010: RRT incidence and use of home dialysis modalities. Nephron. Clin. Pract. 119 (Suppl. 2), c255–c267 (2011).

    Article  PubMed  Google Scholar 

  79. Castledine, C., Gilg, J., Rogers, C., Ben-Shlomo, Y. & Caskey, F. Factors affecting the number of patients treated with either peritoneal or home haemodialysis in the UK [abstract P219]. The Renal Conference 2012 [online], (2012).

    Google Scholar 

  80. Oliver, M. J. & Quinn, R. R. Is the decline of peritoneal dialysis in the elderly a breakdown in the process of care? Perit. Dial. Int. 28, 452–456 (2008).

    PubMed  Google Scholar 

  81. Oliver, M. J. et al. Home care assistance and the utilization of peritoneal dialysis. Kidney Int. 71, 2673–2678 (2007).

    Article  Google Scholar 

  82. [No authors listed] Abstracts of the 14th Congress of the International Society of Peritoneal Dialysis. Kuala Lumpur, Malaysia. Perit. Dial. Int. 32 (Suppl. 3), S89–S188 (2012).

  83. Oliver, M. J. et al. Choosing peritoneal dialysis reduces the risk of invasive access interventions. Nephrol. Dial. Transplant. 27, 810–816 (2012).

    Article  PubMed  Google Scholar 

  84. Povlsen, J. V. & Ivarsen, P. Assisted peritoneal dialysis: also for the late referred elderly patient. Perit. Dial. Int. 28, 461–467 (2008).

    PubMed  Google Scholar 

  85. Lobbedez, T. et al. Is rapid initiation of peritoneal dialysis feasible in unplanned dialysis patients? A single-centre experience. Nephrol. Dial. Transplant. 23, 290–294 (2008).

    Article  Google Scholar 

  86. Brown, E. A., Dratwa, M. & Povlsen, J. V. Assisted peritoneal dialysis—an evolving dialysis modality. Nephrol. Dial. Transplant. 22, 3091–3092 (2007).

    Article  PubMed  Google Scholar 

  87. Castrale, C. et al. Peritoneal dialysis in elderly patients: report from the French Peritoneal Dialysis Registry (RDPLF). Nephrol. Dial. Transplant. 25, 255–262 (2010).

    Article  PubMed  Google Scholar 

  88. Lobbedez, T., Verger, C., Ryckelynck, J. P., Fabre, E. & Evans, D. Is assisted peritoneal dialysis associated with technique survival when competing events are considered? Clin. J. Am. Soc. Nephrol. 7, 612–618 (2012).

    Article  PubMed  Google Scholar 

  89. Brown, E. A. et al. Broadening Options for Long-term Dialysis in the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients. Nephrol. Dial. Transplant. 25, 755–763 (2010).

    Article  Google Scholar 

  90. Piraino, B. et al. ISPD position statement on reducing the risks of peritoneal dialysis-related infections. Perit. Dial. Int. 31, 614–630 (2011).

    Article  CAS  PubMed  Google Scholar 

  91. Li, P. K. et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit. Dial. Int. 30, 393–423 (2010).

    Article  PubMed  Google Scholar 

  92. Brown, M. C., Simpson, K., Kerssens, J. J., Mactier R. A. & Scottish Renal Registry. Peritoneal dialysis-associated peritonitis rates and outcomes in a national cohort are not improving in the post-millennium (2000–2007). Perit. Dial. Int. 31, 639–650 (2011).

    Article  PubMed  Google Scholar 

  93. Burke, M. et al. Relapsing and recurrent peritoneal dialysis-associated peritonitis: a multicentre registry study. Am. J. Kidney Dis. 58, 429–436 (2011).

    Article  PubMed  Google Scholar 

  94. Fahim, M. et al. Culture-negative peritonitis in peritoneal dialysis patients in Australia: predictors, treatment, and outcomes in 435 cases. Am. J. Kidney Dis. 55, 690–697 (2010).

    Article  PubMed  Google Scholar 

  95. Jose, M. D. et al. Peritoneal dialysis practice in Australia and New Zealand: a call to action. Nephrology (Carlton) 16, 19–29 (2011).

    Article  Google Scholar 

  96. Martin, L. C. et al. Geographic and educational factors and risk of the first peritonitis episode in Brazilian Peritoneal Dialysis Study (BRAZPD) patients. Clin. J. Am. Soc. Nephrol. 6, 1944–1951 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  97. Davey, M. S. et al. Human neutrophil clearance of bacterial pathogens triggers anti-microbial γδ T cell responses in early infection. PLoS Pathog. 7, e1002040 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. García-López, E., Lindholm, B. & Davies, S. An update on peritoneal dialysis solutions. Nat.Rev. Nephrol. 8, 224–233 (2012).

    Article  CAS  PubMed  Google Scholar 

  99. Johnson, D. W. et al. The effect of low glucose degradation product, neutral pH versus standard peritoneal dialysis solutions on peritoneal membrane function: the balANZ trial. Nephrol. Dial. Transplant. 27, 4445–4453 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Johnson, D. W. et al. Effects of biocompatible versus standard fluid on peritoneal dialysis outcomes. J. Am. Soc. Nephrol. 23, 1097–1107 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  101. Davies, S. J. What has balANZ taught us about balancing ultrafiltration with membrane preservation? Nephrol. Dial. Transplant. http://dx.doi.org/10.1093/ndt/gfs594.

  102. Davies, S. J., Mushahar, L., Yu, Z. & Lambie, M. Determinants of peritoneal membrane function over time. Semin. Nephrol. 31, 172–182 (2011).

    Article  CAS  PubMed  Google Scholar 

  103. Pletinck, A., Vanholder, R., Veys, N. & Van Biesen, W. Protecting the peritoneal membrane: factors beyond peritoneal dialysis solutions. Nat. Rev. Nephrol. 8, 542–550 (2012).

    Article  CAS  PubMed  Google Scholar 

  104. Lambie, M., John, B., Mushahar, L., Huckvale, C. & Davies, S. J. The peritoneal osmotic conductance is low well before the diagnosis of encapsulating peritoneal sclerosis is made. Kidney Int. 78, 611–618 (2010).

    Article  PubMed  Google Scholar 

  105. [No authors listed] NKF-DOQI clinical practice guidelines for peritoneal dialysis adequacy. National Kidney Foundation. Am. J. Kidney Dis. 30 (Suppl. 2) S67–S136 (1997).

  106. Davies, S. J., Phillips, L., Griffiths, A. M., Naish, P. F. & Russell, G. I. Analysis of the effects of increasing delivered dialysis treatment to malnourished peritoneal dialysis patients. Kidney Int. 57, 1743–1754 (2000).

    Article  CAS  PubMed  Google Scholar 

  107. Gama-Axelsson, T. et al. Serum albumin as predictor of nutritional status in patients with ESRD. Clin. J. Am. Soc. Nephrol. 7, 1446–1453 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Mehrotra, R. et al. Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with haemodialysis. Am. J. Kidney Dis. 58, 418–428 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Rao, R. et al. Effect of change in renal replacement therapy modality on laboratory variables: a cohort study from the UK Renal Registry. Nephrol. Dial. Transplant. 24, 2877–2882 (2009).

    Article  PubMed  Google Scholar 

  110. Van Biesen, W. et al. Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM) study cohort. PLoS ONE 6, e17148 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. John, B. et al. Plasma volume, albumin, and fluid status in peritoneal dialysis patients. Clin. J. Am. Soc. Nephrol. 5, 1463–1470 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  112. Paniagua, R. et al. NTproBNP, fluid volume overload and dialysis modality are independent predictors of mortality in ESRD patients. Nephrol. Dial. Transplant. 25, 551–557 (2010).

    Article  CAS  PubMed  Google Scholar 

  113. Tan, B. K., Chan, C. & Davies, S. J. Achieving euvolemia in peritoneal dialysis patients: a surprisingly difficult proposition. Semin. Dial. 23, 456–461 (2010).

    Article  PubMed  Google Scholar 

  114. Movilli, E. et al. Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. A 5-year prospective observational multicentre study. Nephrol. Dial. Transplant. 22 3547–3552 (2007).

    Article  PubMed  Google Scholar 

  115. Arbor Research Collaborative for Health. Peritoneal Dialysis Outcomes and Practice Patterns Study: Dialysis Outcomes and Practice Patterns Study expands to study peritoneal dialysis. Arborresearch.org [online] (2013).

  116. Winterbottom, A., Bekker, H. L., Conner, M. & Mooney, A. Choosing dialysis modality: decision making in a chronic illness context. Health Expect. http://dx.doi.org/10.1111/j.1369-7625.2012.00798.x.

  117. European Training & Research in Peritoneal Dialysis. Project EuTRiPD. EuTRiPD [online], (2012).

Download references

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.

Author information

Authors and Affiliations

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

    Simon J. Davies

Authors
  1. Simon J. Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

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

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneph.2013.100

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing