Past, present, and future of quantified peritoneal dialysis

The role of peritoneal dialysis (PD) as a modality in renal replacement the rapy has been well established. In this article we review various aspects i n the evolution of PD, with special emphasis on adequacy. Until the late 19 50s PD was still considered as a last resort in the treatment of terminal u remia. The introduction of a chronic indwelling catheter made chronic PD po ssible. The concept of continuous ambulatory peritoneal dialysis (CAPD), pr oposed in 1975, had a major impact on the way PD was performed later. The v alue of determining the adequacy, using urea clearance normalized to total body water (Kt/V) or creatinine clearance normalized to body surface area, was clearly highlighted by the Canada-USA (CANUSA) study. Introduction of s tandardized peritoneal equilibration tests has been very helpful in enhanci ng the efficiency of PD. In 1995 the National Kidney Foundation-Dialysis Ou tcomes Quality Initiatives (NKF-DOQI) established guidelines to improve pat ient survival and outcome on dialysis. These guidelines established minimum criteria for PD adequacy. Compliance and malnutrition remain important fac tors determining the efficacy of PD. The "healthy start" concept emphasizes an early start of dialysis in patients with end-stage renal disease (ESRD) . The quest for an ideal PD modality has recently led to renewed interest i n the idea of continuous flow peritoneal dialysis (CFPD). PD continues to g row and at the same time faces many challenges. Its role as a renal replace ment therapy is likely to evolve further in the years to come.