International Urology and Nephrology 35: 569–577, 2003. © 2004 Kluwer Academic Publishers. Printed in the Netherlands. 569 Can peritoneal dialysis be used as a long term therapy for end stage renal disease? Michele Giannattasio 1 , Michele Buemi 2 , Flavia Caputo 3 , Giusto Viglino 4 & Enrico Verrina 5 1 Struttura Complessa di Nefrologia e Dialisi, Azienda USL Bari 5 Putignano, Italy; 2 Cattedra di Nefrologia, Di- partimento di Medicina Interna, Universit` a di Messina, Italy; 3 Unit` a Medica Trapianto di Rene, Ospedale Civico Palermo, Italy; 4 Unit` a Operativa di Nefrologia e Dialisi, Azienda USL 18 Alba, Italy; 5 Divisione di Nefrologia, Dialisi e Trapianto, Istituto G. Gaslini Genova, Italy Abstract. Over the last 25 years, since the introduction of CAPD, the use of PD has increased greatly and over this period many advances in technique have been made. As is well known, that home and self-dialysis, such as PD, cost less than in-center HD and can provide excellent survival and a high level of patient rehabilitation. To date however, the demonstration that PD can provide long term dialysis has been limited to a small number of patients. The next few decades will see a marked increase in the worldwide dialysis population, particularly as older and sicker patients are accepted into dialysis. It is likely that worldwide pressures related to cost containment will favour the use of cost effective therapies, such as PD. However, the increased use of PD will continue, only if we continue to improve its efficacy and do not waste the economic benefits gained over HD. We are challenged to improve and develop PD in a way that optimises patient medical and psychosocial outcomes while minimizing costs. This may be achieved by using more biocompatible solutions, hopefully inexpensive, that will maintain the peritoneal membrane intact for long periods, will better preserve the membrane’s transport characteristics over time, and thus reduce the main causes of drop out from dialysis. Key words: Adequacy, Drop out, ESRD, Long term PD, Pediatric PD patients, Technique survival on PD, UF failure Introduction Over the last few years the number of persons on renal replacement therapy has been increasing steadily because there is an older dialysis population due to the acceptance of progressively older patients into such therapy and to the improvement of the clinical and technical knowledge which has decreased mortality rates among the older patients. Also, the number of kidney transplants has remained low. The coming years will see a marked increase in the dialysis popula- tion but the resources available for health care services have been decreasing worldwide. Therefore, the scen- ario for the treatment of end stage renal disease (ESRD) over the next few years probably will be characterised by the following factors of predictable evolution: • For ethical and deontological reasons, society will continue to forbid refusal of dialysis treatment on the grounds of age or for social or economic reasons; • Increasing efforts to decrease dialysis costs using less expensive treatments and the introduction of project financing (i.e. a loan for the capital costs of a project is repaid from cash flow associated with the operation of the project [1]); • Preference for self care or home dialysis treatment; • Increasing involvement of patient, family and social services; • Establishment or improvement of outpatient facil- ities throughout the world • Refining of technical and clinical research to reach the above mentioned goals. In this new scenario peritoneal dialysis (PD) should play a major role because it is the most practicable home dialysis treatment. Compared to hemodialysis (HD), PD has lower costs and the same or better short term survival. Moreover, it is the treatment