[The reality on peritoneal dialysis in France: 40years after].

The share of peritoneal dialysis (PD) in the spectrum of chronic dialysis has decreased in France over the last ten years. Despite various facilities offered by the health authorities, PD remains confidential in many private units and some public hospitals. The enthusiasm present at the beginning of this technology, forty years ago, is declining, despite a real improvement in new developments, a real increase in patient survival, today at least similar to that on hemodialysis. Then, the aim of this review is first to give a summary of the principles and practice of patient and staff education and to describe the role of the medical contribution in decision-making. The second aim is to review patient and technique survival data of PD patients henceforth prolonged, and the new insights into dialysis adequacy. The presence of residual renal function is a main determinant of patient comfort together with prevention of over-hydratation. Improvement of the peritoneal catheter is underlined. The prevention and management of infections is reviewed, and also the regular assessment of peritoneal function. Free water transport is a predictor of encapsulating peritoneal sclerosis, which should be assessed regularly. The physiopathology and the pathogenesis of this devastating complication allow now the prevention, and a better treatment.