The future of peritoneal dialysis in the United States: optimizing its use.

Peritoneal dialysis (PD) has been used to treat patients with stage V chronic kidney disease since 1976. However, despite this long history, as of 2008 <8% of prevalent ESRD patients in the United States are treated with PD, a modality mix that is significantly different from what is seen in other developed countries. Data are reviewed that suggest that the reasons for this seem to be caused by non-medical-related issues such as subtle differences in practice patterns and unintended financial considerations. Medical outcome date would seem to favor more utilization of PD. For instance, data from the USRDS suggested that the relative risk of death for PD versus center hemodialysis has been improving, tending to favor those on PD for longer and longer periods of time. Infectious complications have also been markedly reduced. It is anticipated that changes in government reimbursement, such as the bundling of dialysis-related services, will stimulate a renewed interest in home therapies. Currently most home dialysis units are small, and some have minimal clinical experience with PD. If trends in reimbursement do favor a renewed interest in PD, for patient outcomes on PD to continue to improve, there will likely need to be further educational activities focused on PD, and perhaps, consolidation of PD programs may needed.