Peritoneal dialysis is not a superior therapy to hemodialysis: a comparison.

After initial reports suggesting that patients initiating peritoneal dialysis (PD) had better survival than patients on conventional dialysis in the first year, many investigators have scrutinized the existing databases to determine the reasons for this apparent difference. It is clear that patients starting on PD are selected - they are younger and have less comorbidity compared to the general population on dialysis. Despite improvements in the morbidities of patients on PD over the past 15 years, the survival of patients on hemodialysis over 5 years is greater than for patients on hemodialysis. The latest analysis points to the considerable survival difference in patients who start dialysis with an arteriovenous fistula or graft compared to patients who start dialysis with a cuffed catheter. Thus, the apparent early survival advantage for patients starting PD can be attributed to selection and comorbidities. Data are emerging that the best survival occurs when patients are dialyzed more frequently than the conventional three times a week. The questions regarding dialysis modality now can shift from whether to encourage PD to how to encourage frequent hemodialysis.