The Role of Peritoneal Dialysis as First Modality in an Integrative Approach to Patients with End-Stage Renal Disease

More than twenty years after the introduction of the “portable/wearable dialysis system” by Popovich and Moncrief (1), peritoneal dialysis has become an established modality for the treatment of end-stage renal failure (2). However, the exact place of peritoneal dialysis (PD) in the complete armamentarium of therapies for end-stage renal disease (ESRD) is not yet established. ESRD patients should be prepared in a timely manner by a specialized renal care team for lifelong treatment. It is our thesis that, whenever possible, dialysis treatment should start with peritoneal dialysis. But the team should offer adequate pre-ESRD care and all renal replacement therapies (RRTs)—including peritoneal dialysis, hemodialysis (HD), and renal transplantation—in a fair and logical way that is also adapted to the specific needs and possibilities of an individual patient. Patients should be further instructed that transfers between RRT modalities are possible, and that the treatment approach will be such that, at any time, their treatment will be the modality most optimal for them at that moment. This strategy is called an “integrative care” approach, as it considers all forms and modalities of RRT to be part of a full spectrum of treatment, and not competitors, as they are often considered.