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Titolo	Proliferation of Hemodialysis Units and Declining Peritoneal Dialysis Use: An International Trend
Autore	Peter Blake, MB, FRCPC - University ofWestern Ontario - Ontario, Canada
Referenza	Am J Kidney Dis 2009; 54 (2): 289-298
Contenuto	Proliferation of Hemodialysis Units and Declining Peritoneal Dialysis Use: An International Trend - American Journal of Kidney Diseases - August 2009 (Vol. 54, Issue 2, Pages 289-298) Peter Blake, MB, FRCPC Refers to article: Ownership Patterns of Dialysis Units and Peritoneal Dialysis in the United States: Utilization and Outcomes , 09 April 2009 Rajnish Mehrotra, Osman Khawar, Uyen Duong, Linda Fried, Keith Norris, Allen Nissenson, Kamyar Kalantar-Zadeh American Journal of Kidney Diseases - August 2009 (Vol. 54, Issue 2, Pages 289-298) Use of peritoneal dialysis (PD) for the treatment of end-stage renal disease (ESRD) has Decreased sharply in many developed countries during the past 15 years. This decrease has been particularly marked in the United States, where the proportion of dialysis patients on PD therapy has decreased from 14% to 8%.2 In this issue of the American Journal of Kidney Diseases, Mehrotra et al3 use the US Renal Data System database to look at the interaction between PD use and ownership pattern of dialysis units during 1996 to 2004. They show a disproportionate increase in the percentage of patients treated by large dialysis organizations (LDOs). They report that LDO units generally use PD less than non-LDO units, and also that some LDO units have consistently lower PD use than others. They find that the LDOs with low PD use had greater mortality and technique failure rates with PD. PD is not a panacea for every patient; however, outcome studies from a variety of countries suggest that it is an effective modality for many. Given a free choice, as many as 50% of patients choose the modality.19 Furthermore, PD is cost-effective and consistent with modern paradigms of patient empowerment and autonomy. There is a serious risk that its use will fade away to insignificance in the United States if present trends continue and more innovative approaches are not made. LDOs in particular need to take on board the findings of the study by Mehrotra et al.
Data	29.07.2009

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