Nephrol Dial Transplant (2001) 16: 61-66
© 2001 European Renal Association-European Dialysis and Transplant Association
Integrated end-stage renal disease care: the role of peritoneal dialysis
Optimal Dialysis Research Unit, London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada
Abstract
This paper reviews the rationale behind the proposed policy of using peritoneal dialysis (PD) as the initial treatment modality in patients with end-stage renal disease (ESRD). The better preservation of residual renal function associated with PD is emphasized along with its potential cardiovascular benefits. The superior patient survival on PD, relative to hemodialysis, during the first 2 years on dialysis in both the United States and Canada is discussed, as are the potential advantages of PD in terms of hepatitis C prevention, anaemia management and quality of life. The lower cost of PD in association with these clinical advantages lead to the modality being more cost-effective in the early years on dialysis. The relatively high technique failure rate on PD, however, subsequently leads to an increasing need for haemodialysis. A policy of integrated dialysis care with PD first and then haemodialysis, as required, is advocated as a more cost-effective approach to ESRD in suitable patients.
Keywords: cardiovascular disease; integrated ESRD care; peritoneal dialysis; residual renal function
Notes
Correspondence and offprint requests to: Dr Peter Blake, Division of Nephrology, London Health Sciences Centre, Victoria Campus, 375 South Street, London, Ontario, Canada N6A 4G5.