Given the discussion so far, it might be apparent that factors beyond efficacy have dictated the decline in the use of PD for ARF. The importance of these factors should not be underestimated. They might be related to the perceived "labor intensive" aspect of PD, fear of a malfunctioning catheter (which in some instances may be real), insufficient exposure to PD during nephrology training, and, last, the comfort offered by the technology used for HD. Such psychological barriers are difficult to overcome, much more so than technical barriers (which can be and have been overcome). Only a concentrated effort by the PD community in educating the general nephrologist concerning the feasibility of PD in ARF, better clinical trials that harness the full potential of PD, and careful patient selection for the use of PD will bring PD back to the mainstream in the treatment of ARF.

Copyright © 2003 by Multimed Inc.