Technical Aspects of Peritoneal Dialysis
1. The main clinical benefit of peritoneal dialysis (PD) is that it allows for greater flexibility and lifestyle choices inherent in home-suitable kidney replacement therapy.
2. Initiating incident patients on PD (i.e., “PD First”) offers survival and other clinical benefits, particularly in situations where renal replacement is unplanned or a central venous catheter would otherwise be used.
3. The continuous nature of PD affords greater hemodynamic stability by avoiding rapid shifts in intravascular volume and rapid transcellular shifts of electrolytes. These features help maintain circulatory integrity and tissue perfusion, factors potentially compromised by intermittent renal replacement therapies.
4. Residual kidney function is associated with survival benefits and is better preserved with PD than intermittent hemodialysis.
5. Initiating incident patients on PD preserves the vasculature for future access, maintaining more downstream kidney replacement options.