Indications for Peritoneal Dialysis
What are the indications for and clinical benefits of Peritoneal Dialysis?
Peritoneal Dialysis can be performed in any patient who has end-stage kidney disease (ESKD) and has intact peritoneal anatomy and function. Specific contraindications are discussed later.
The main clinical benefit of PD is that it allows patients the flexibility and lifestyle choices inherent in a home-suitable kidney replacement therapy. It also has an advantage in providing continuous removal of waste and fluid, similar to the continuous function provided by the kidneys. The resulting physiologically gentle means of dialysis is thought to contribute to better preservation of existing residual kidney function (RKF). Maintenance of RKF has been shown to provide survival advantage for patients with ESKD. The continuous nature of PD also affords greater hemodynamic stability and avoids rapid transcellular shifts of fluids and electrolytes. These features help maintain circulatory integrity and tissue perfusion, factors potentially compromised by intermittent renal replacement therapies.
Initiating renal replacement therapy (RRT) with PD also helps preserve vasculature for future vascular access as part of an “integrated therapy” strategy for patients anticipated to require multiple RRTs (PD, transplant, home hemodialysis [HD], in-center HD) over their lifetime. As such, a RRT strategy of “PD first” is one advocated by an increasing number of clinicians when a preemptive kidney transplant is not available. This approach could also reduce the need for central venous catheters (CVCs) in patients needing an unplanned dialysis start.
Better preservation of RRF, avoidance of compromised cardiac, brain, and gut perfusion, as well as avoidance of CVCs may help explain the apparent survival advantage reported in retrospective observational analyses of propensity matched-PD and HD-treated incident ESKD cohorts.