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Epidemiology of peritoneal dialysis: a story of believers and nonbelievers

Abstract

In 2008, an estimated 1.77 million patients worldwide received dialysis. Of these patients, 1.58 million were treated with hemodialysis and approximately 190,000 received peritoneal dialyisis. In a global comparison of treatment methods for renal failure, therefore, hemodialysis clearly dominates. In this Review, we compare the epidemiology of peritoneal dialysis with that of hemodialysis and describe some of the major differences in the global utilization of the two dialysis modalities. These differences can largely be explained by a number of nonmedical, mainly economic factors, but also by educational and psychological factors. To reverse the current trends, the implementation of suitable reimbursement strategies for peritoneal dialysis is needed as well as increased investment in the training of young nephrology fellows and in education programs for patients and other non-nephrological health-care providers. To achieve these goals, academic and nonacademic training centers, which often consider peritoneal dialysis to be a low-level priority, must invest in research and training related to peritoneal dialysis.

Key Points

  • The prevalence of peritoneal dialysis differs substantially between regions; these differences cannot solely be explained by medical factors; economic factors and dogmatic beliefs are also believed to have an important role

  • In regions or centers with a high prevalence of peritoneal dialysis, the outcome for patients on peritoneal dialysis is at least as good as for those on hemodialysis

  • Patient choice of dialysis modality is an important predictor of outcome; as such, each center should offer both peritoneal dialysis and hemodialysis to their patients in an unbiased way

  • The prevalence of automated peritoneal dialysis use is increasing worldwide, although continuous ambulatory peritoneal dialysis and automated peritoneal dialysis perform equally well in terms of survival

  • Automated peritoneal dialysis can be beneficial in patients with a fast transport status, but again, patients should be free to choose the dialysis modality used

  • The education of patients and trainee nephrologists on all aspects of peritoneal dialysis is a prerequisite for promoting peritoneal dialysis; scientific societies should stimulate educational and research activities related to peritoneal dialysis

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Figure 1
Figure 2: Worldwide prevalence of peritoneal dialysis in 2006 expressed as a percentage of the total dialysis population.
Figure 3: Prevalence of peritoneal dialysis in different regions.

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Correspondence to Norbert Lameire.

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Lameire, N., Van Biesen, W. Epidemiology of peritoneal dialysis: a story of believers and nonbelievers. Nat Rev Nephrol 6, 75–82 (2010). https://doi.org/10.1038/nrneph.2009.210

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