Hippokratia 2011; 15 (Suppl 2): 15-20
Peritoneal Dialysis (PD) has been established as an effective renal replacement therapy complementary to hemodialysis (HD) for End-Stage Renal Disease (ESRD) patients. However, its prevalence has been decreasing during the last decades in Western Europe and USA, whereas in some regions such as Hong Kong or Mexico its penetration remains higher than 70%. These dramatic differences around the world can not be explained only by medical reasons. There are also many "hidden" factors such as financial issues (for profit HD), completely unproven dogmatic beliefs about the superiority of HD over PD, or more recently a fear about "the epidemic" of encapsulating peritoneal sclerosis in long standing PD. During the last two decades, there has been a significant progress in many fields of PD, such as reduced PD related peritonitis rates by new connectology systems, prevention of exit site infections by mupirocin or gentamycin ointments, wide application of automated PD by reliable cyclers, use of icodextrin for the long exchanges, better preservation of residual renal function, newer and more biocompatible PD solutions and timely placement of PD catheters by nephrologists. In addition, basic and clinical research is focusing on future improvements such as the use of two icodextrin exchanges per day, the application of new PD solutions with low sodium concentration, the wider use of "assisted" PD, and a better understanding of the pathogenetic mechanisms that may lead to peritoneal sclerosis with new therapies that may prevent it. The dilemma regarding the best modality for ESRD (HD or PD?) should be abandoned and the modern nephrologist should be wise enough to recognize the possible advantages and contraindications of each modality and confident enough to offer both of them to the ESRD patients as appropriate.