Peritoneal Dialysis: Where is it Now and Where is it Going?

It is now more than 25 years since Popovich and Moncrief first described the principles of continuous ambulatory peritoneal dialysis (CAPD) and their impressive experience with their first patients (1). The only negative point in this procedure was the extremely high peritonitis rate (one episode every 3-4 patient months). Subsequently, developments such as the Toronto Western Hospital Technique for CAPD (2) and Buoncristiani’s Y-set technique (3) decreased the peritonitis rates to one episode every 12 months and to one episode every 24-34 months respectively, thus allowing worldwide use of CAPD. Furthermore the introduction of cycler techniques that allow dialysis at night with uninterrupted daytime activity, improved the patients’ quality of life and made automated peritoneal dialysis (APD) attractive for new patients with ESRD when considering their dialysis options. More recently, the introduction of more biocompatible solutions and solutions designed to increase ultrafiltration (UF) for the long dwell have been shown to further enhance the therapy. Thirty to 40% of well-informed new patients prefer various forms of chronic peritoneal dialysis (CPD) (4), and today almost 15% of all dialysis patients worldwide are treated with this technique (5).