Long-term survival on peritoneal dialysis is not a dream anymore: lessons from the East.

摘要

The decline of peritoneal dialysis (PD) in North America, especially in the United States (1,2), and Europe (3,4) has left those who believe in the benefits of this mode searching for reasons for this fall off, hoping to address them and so reverse the trend. One reason for the decline in the use of PD is its perceived poor performance with respect to patient and technique survival over the long term. It is interesting that, although all the registries have indicated that PD has better survival rates than hemodialysis during the first 1-2 years, and similar rates afterwards, this evidence has not been enough to convince the doubters to change their minds. This resistance may be related to the fact that, despite the increased early survival on PD, the rates of technique failure have always been substantial, especially in earlier years when peritonitis rates were higher and annualtech-nique failure was 20% - 30%. Fortunately, the introduction of the double-bag system broughta dramatic decline in peritonitis rates worldwide, and techniques failures also have been falling (5). However, old impressions still grip the minds of those caregivers who influence patients' decision-making concerning their dialysis options, and therefore the use of PD in many countries has continued to decline.