Why Start PD?

                                     This is a video on how PD works.

            Our long-term goals in caring for patients with renal failure are to improve morbidity and mortality and preserve quality of life to the best possible degree.

            Many patients, especially younger patients, will likely need HD, PD, and renal transplantation at different times over their lifetime.

            Residual renal function is an important predictor of survival in the early years of RRT, and strategies to preserve residual renal function may add years of benefit to patients.

1. The preservation of residual renal function may in fact confer an important survival benefit in PD, as peritoneal dialysis patients have a slower rate of decline of residual renal function than do HD patients.

For example, Wang and colleagues reported that for every 1 mL/min/1.73 m2 increase in residual glomerular filtration rate (GFR), there was a 50% reduction in all-cause mortality and cardiovascular death among their cohort of PD patients.

2.Once there is no residual renal function, it is more difficult to achieve solute clearance with PD than with hemodialysis. Therefore, it makes much more sense to utilize peritoneal dialysis at the beginning of renal replacement therapy rather than as a last resort in the setting of vascular access failure. Using PD for dialysis initiation delays the use of hemodialysis and preserves upper extremities for vascular access.

              In addition to the benefits of preserving residual renal function and vascular access sites, numerous studies suggest that patient satisfaction is higher in patients on PD versus HD.

Among the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) cohort, patients who were receiving peritoneal dialysis were 1.5 times more likely to rate their dialysis care as excellent than were patients receiving HD.

3.PD patients in the CHOICE cohort were also more satisfied with the availability of their nephrologists than were hemodialysis patients, despite the fact that in-center HD patients are typically seen more frequently by their nephrologists.

(credit to Tucker, J Kevin MD; Denker, Bradley M. MD)

Fig. 1 Peritoneal Dialysis in a glance.