Peritoneal Dialysis Techniques and Patient Outcomes

Peritoneal dialysis (PD) is a home-based renal replacement therapy in which the peritoneal membrane acts as a semi-permeable barrier to remove solutes and fluid. Techniques have evolved from continuous ambulatory PD (CAPD) to automated cycler-assisted PD (APD), and include urgent-start protocols for unplanned initiation. Optimisation of dialysate composition, catheter design and patient training has reduced infectious and mechanical complications, thereby improving technique survival. Key patient outcomes encompass mortality, modality switch, quality of life and preservation of residual renal function. While infectious peritonitis remains a leading cause of technique failure, advances in solution biocompatibility and membrane monitoring have diminished long-term injury. Comparative studies indicate that PD often confers superior early health-related quality of life compared with haemodialysis, particularly in physical and psychological domains. Demographic and clinical factors—such as age, comorbidity and glycaemic control—shape both technical success and long-term prognosis. Globally, PD offers advantages in resource-limited settings, promoting patient autonomy and reducing costs when supported by trained multidisciplinary teams.

Research from Nature Portfolio

Recent analyses of large registry cohorts have clarified the links between causes of technique failure and subsequent survival. One study found that peritonitis-related and social-related discontinuations of PD confer a significantly higher risk of mortality within two years, whereas failures due to inadequate dialysis or mechanical issues do not carry the same early mortality burden. Another investigation tracked health-related quality of life over two years in incident dialysis patients and reported that those on PD maintained higher scores in domains such as burden of kidney disease and dialysis staff encouragement, even though both PD and haemodialysis groups experienced gradual declines in overall well-being.

Peritoneal Dialysis Techniques and Patient Outcomes publication trend

The graph below shows the total number of articles in peritoneal dialysis techniques and patient outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Peritoneal Dialysis (PD): A renal replacement therapy using the peritoneal membrane for solute and fluid exchange via instilled dialysate.

Haemodialysis (HD): A blood purification method using an external machine and vascular access to remove waste products and excess fluid.

Technique Failure: Discontinuation of PD owing to complications necessitating transfer to an alternative dialysis modality.

Health-Related Quality of Life: A patient-centred measure of physical, mental and social well-being in the context of disease and its treatment.

Peritonitis: Inflammation of the peritoneal membrane, typically due to bacterial infection, and a major PD complication.

Catheter Patency: The maintained openness and proper function of the peritoneal dialysis catheter enabling effective fluid exchange.

References

1. Glycosylation and Characterization of Human Transferrin in an End-Stage Kidney Disease. International Journal of Molecular Sciences (2024).
2. Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre. BMC Nursing (2024).
3. Timing, causes, predictors and prognosis of switching from peritoneal dialysis to hemodialysis: a prospective study. BMC Nephrology (2009).
4. Broadening Options for Long-term Dialysis in the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients. Nephrology Dialysis Transplantation (2010).
5. Urgent-Start Peritoneal Dialysis and Hemodialysis in ESRD Patients: Complications and Outcomes. PLOS ONE (2016).
6. Better Quality of Life of Peritoneal Dialysis compared to Hemodialysis over a Two-year Period after Dialysis Initiation. Scientific Reports (2019).
7. Peritoneal Dialysis Drop‐out: Causes and Prevention Strategies. International Journal of Nephrology (2011).
8. Association between causes of peritoneal dialysis technique failure and all-cause mortality. Scientific Reports (2018).