Socioeconomic aspects of peritoneal dialysis in North America: Role of nonmedical factors in the choice of dialysis

Patients initiating dialysis therapy must make a choice between hemodialysi s (HD) and peritoneal dialysis (PD). Controversy persists over the relative merits of each modality in the treatment of end-stage renal disease (ESRD) . Issues relating to survival, morbidity, economics, and patient characteri stics will all determine the final choice of therapy. Non medical factors a re the most important determinant of dialysis modality selection. In the United States, HD has been the more commonly used modality, while PD is underrepresented. This disparity arises from multiple factors including reactions (sometimes incorrect) to the healthcare financing structure, phy sician biases, and changing demographic patterns in the ESRD population. We discuss these issues and present collected evidence showing that increased use of PD may have substantial overall benefit.