Peritoneal dialysis: misperceptions and reality.

Peritoneal dialysis (PD) continues to be underutilized in the United States, even though it is less expensive, provides better quality of life and has better outcomes compared with hemodialysis. The reasons for low utilization of PD are influenced by complex psychosocial and economic factors, lack of physician training, physician bias and inadequate pre-end-stage renal disease care and education to the patients. Providing quality pre-end-stage renal disease education to patients and families and improving education and training of physician in PD, so that they become comfortable with the therapy, are of paramount importance to increase PD growth. Minimizing episodes of PD-related infections and noninfectious complications, preserving peritoneal membrane using more biocompatible solutions and drugs, such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and careful management of volume status can reduce the loss of PD patients to hemodialysis. Timely surgical interventions can prevent the malfunction and loss of PD catheters. Consolidating smaller PD facilities in a given geographical area into a single large PD center can further improve PD outcomes and PD growth. Finally, with the introduction of bundled payment for dialysis services, PD may emerge as a cost-effective therapy and rekindle interest in the dialysis community to consider PD as a better renal replacement therapy option.