Dialysis or transplantation: fitting the treatment to the patient.

Early referral of the patient with chronic renal failure will give the nephrologist time to fit the treatment to the patient. Planning for dialysis and transplantation should be undertaken concurrently. If the patient is not of advanced age and is not afflicted with severe comorbid illness, renal transplantation is the preferred form of renal replacement therapy. Living donor transplantation is preferred to cadaveric transplantation. For the patient who awaits or who cannot undergo transplantation, either peritoneal dialysis or hemodialysis may be chosen. Although the mortality rate for peritoneal dialysis appears to be higher than that for hemodialysis, especially among elderly diabetic patients, peritoneal dialysis remains an acceptable therapy for the highly motivated patient. In the United States, the mortality rate for chronic dialysis patients is high. We expect mortality rates for both peritoneal dialysis and hemodialysis to fall, however, as we strive to achieve optimal solute clearance and to more effectively treat comorbid illness.