Trends in patient and technique survival in peritoneal dialysis and strategies: How are we doing and how can we do better?

The best data on long term trends in patient and technique survival on dial ysis come from North America. Mortality rates on both peritoneal (PD) and h emodialysis (HD) have fallen over the past one to two decades in both the U S and Canada with the decline in the US being relatively greater in older a nd diabetic patients. There is some suggestion that this improvement may be proportionately greater in PD, relative to HD, patients in both the US and Canada. Overall, mortality rates on PD are similar to, or better than, tho se on HD in the early years of treatment, except in older US diabetic patie nts. In later years, patients on HD do relatively better than those on PD i n the US but not in Canada. The biggest cause of mortality on dialysis is c ardiovascular disease and the risk factors for this in the dialysis populat ion generally, and particularly on PD, are reviewed, including newly apprec iated ones such as hyperhomocysteinemia. high lipoprotein (a) levels and in flammation/malnutrition. Possible preventative and therapeutic strategies a re also considered. Technique failure (TF) rates are high in PD but Canadia n data suggest they have fallen over the past 20 years, primarily due to a reduction in cases due to peritonitis. TF rates due to inadequate dialysis have increased and an interpretation of this as well as an approach to redu cing it are suggested. (C) 2000 by the National Kidney Foundation, Inc.