Is the Decline of Peritoneal Dialysis in the Elderly a Breakdown in the Process of Care?

cal outcomes (1,2). Prospective studies demonstrate that between 64 % and 75 % of incident end-stage renal dis-ease (ESRD) patients are eligible for PD, and that be-tween 45 % and 50 % will choose it as their chronic modality when PD is offered (3–6). The incident use of PD in these studies was between 34 % and 39%, demon-strating that PD use can be high if a rigorous approach to how patients are assessed and offered PD is taken. However, the utilization of PD in practice is variable and, overall, is on the decline. In Europe, the percentage of patients 75 years or older treated with PD as their initial modality ranges from 2 % to 33 % (7), while only 6.6 % of patients are treated with PD in the United States (8). In Ontario, Canada, the prevalent use of PD has fallen from 50 % to 18 % over the past 20 years (9).