Peritoneal dialysis and kidney transplantation: A round-trip ticket without leaving home

Advanced chronic kidney disease requires a longitudinal and integrated approach that combines the different modalities of kidney replacement therapy (KRT). In this context, kidney transplantation is considered the optimal option for eligible patients. However, pre-emptive transplantation is not always feasible, and many patients require dialysis before transplantation or following graft failure. This narrative review examines the role of peritoneal dialysis (PD) within an integrated KRT model, with particular emphasis on its use as first-line therapy, as a bridge to kidney transplantation and after graft failure. The available evidence, derived mainly from observational studies, registries, and meta-analyses, indicates that PD provides outcomes at least comparable to conventional haemodialysis in terms of patient survival. In addition, PD may offer specific advantages in the transplant setting, including a lower risk of delayed graft function and a higher likelihood of access to kidney transplantation or re-transplantation in selected patients. Furthermore, as a home-based therapy, PD may enhance patient autonomy, health-related quality of life, employability, and the sustainability of healthcare systems. Nevertheless, despite Spain’s leading position in kidney transplantation, the relatively low uptake of PD highlights persistent organisational, structural, and cultural barriers that limit its effective integration into routine care. Within this framework, PD should be considered as a preferred option within a continuous, patient‑centred KRT model. Key priorities include increasing PD initiation rates to 30%, consolidating its superior role as a bridge to transplantation, and enabling efficient transitions back to PD after graft failure to preserve quality of life while maintaining re-transplantation options.