Peritoneal dialysis compared with hemodialysis in the treatment of end-stage renal disease

Whether to use peritoneal dialysis (PD) or hemodialysis (HD) is a major dec ision in terms of clinical outcome and management implications; the final c hoice is difficult because of the conflicting results of comparisons report ed in the literature. A review of studies comparing survival shows either s uperiority of HD, or superiority of PD, or equivalence of the two technique s, but an analysis of the comparisons as a whole brings to light two clear phases in the survival curves. In the first, residual renal function (RRF) gives PD an advantage, or at least puts it on the same level as HD. In the second phase, the reduction in Kt/V as RRF declines gives PD a potential ri sk. After a few years of PD treatment a sharp watch is therefore necessary to detect signs of under-dialysis promptly and to shift the patient to HD, In patients without RRF it is more difficult to control hypertension with P D and they are more prone to hyperhydration. Despite a widespread belief in the Eighties that PD was the treatment modality of election for diabetics, HD is in fact preferable in these patients, except younger ones. High-turn over and low-turnover bone lesions are more frequent respectively in HD and PD patients. Anemia is better controlled with PD, Blood lipids and nutriti onal indices are less well controlled with PD. Despite poor technical survi val, the "pool" of patients treated with PD frequently reaches 20-30% becau se it is indicated as first treatment in a large proportion. PD preserves r enal function better than HD and is useful while awaiting renal transplanta tion, with faster postoperative restoration of diuresis. The quality of lif e with PD as home treatment is usually better than with HD, In conclusion, dialytic centers should establish an integrated PD/HD programme as the two methods are not competitive but are different tools for the treatment and r ehabilitation of uremic patients.