Peritoneal Dialysis in Western Countries

Background: Peritoneal dialysis (PD) for the treatment of end-stage renal failure was introduced in the 1960s. Nowadays it has evolved to an established therapy that is complementary to hemodialysis (HD), representing 11% of all patients treated worldwide with dialysis. Despite good clinical outcomes and similar results in patient survival between PD and HD, the penetration of PD is decreasing in the Western world. Summary: First the major events in the history of the development of PD are described. Then important insights into the physiology of peritoneal transport are discussed and linked to the changes in time observed in biopsies of the peritoneal membrane. Furthermore, the developments in peritoneal access, more biocompatible dialysate solutions, automated PD at home, the establishment of parameters for dialysis adequacy and strategies to prevent infectious complications are mentioned. Finally non-medical issues responsible for the declining penetration in the Western world are analyzed. Key Messages: Only after introduction of the concept of continuous ambulatory PD by Moncrief and Popovich has this treatment evolved in time to a renal replacement therapy. Of all structures present in the peritoneal membrane, the capillary endothelium offers the rate-limiting hindrance for solute and water transport for the diffusive and convective transport of solutes and osmosis. The functional Received: May 5, 2015 Accepted after revision: June 30, 2015 Published online: September 3, 2015 Dirk G. Struijk, MD, PhD Dianet Location Amsterdam, University of Amsterdam P.O. Box 22700 NL–1100 DE Amsterdam (The Netherlands) E-Mail d.g.struijk @ amc.uva.nl © 2015 S. Karger AG, Basel 2296–9381/15/0013–0157$39.50/0 www.karger.com/kdd For peritoneal dialysis in Asia, see Kwong and Li, Kidney Dis 2015; 1: