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Perit Dial Int 27(2): 125-130 2007
© 2007 International Society for Peritoneal Dialysis
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THE JOHN F. MAHER AWARD RECIPIENT LECTURES 2006

THE CONTINUUM OF CHRONIC KIDNEY DISEASE AND END-STAGE RENAL DISEASE: CHALLENGES AND OPPORTUNITIES FOR CHRONIC PERITONEAL DIALYSIS IN THE UNITED STATES

Rajnish Mehrotra

Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, and David Geffen School of Medicine at UCLA, Los Angeles, California, USA

Correspondence to: R. Mehrotra, 1124 W. Carson Street, Torrance, California 90502 USA.
rmehrotra{at}labiomed.org

End-stage renal disease (ESRD) patients undergoing renal replacement therapy have a high mortality rate and suffer from considerable morbidity. Degree of nutritional decline, disordered mineral metabolism, and vascular calcification are some of the abnormalities that predict an adverse outcome for ESRD patients. All these abnormalities begin early during the course of chronic kidney disease (CKD), long before the need for maintenance dialysis. Thus, CKD represents a continuum of metabolic and vascular abnormalities. Treatment of these abnormalities early during the course of CKD and a timely initiation of dialysis have the potential of improving patient outcomes. However, the thesis that successful management of these abnormalities will favorably modify the outcomes of dialysis patients remains untested.

The proportion of incident USA ESRD patients starting chronic peritoneal dialysis (CPD) has historically been low. Limited physician training and inadequate predialysis patient education appear to underlie the low CPD take-on in the USA. Furthermore, two key changes have occurred in the USA: steep decline in CPD take-on and progressive increase in the use of automated peritoneal dialysis. The decline in CPD take-on has afflicted virtually every subgroup examined and has occurred, paradoxically, when the CPD outcomes in the country have improved. Understanding the reasons for historically low CPD take-on and recent steep declines in utilization may allow the development of plans to reverse these trends.

KEY WORDS: KEY WORDS:; End-stage renal disease; chronic kidney disease; chronic peritoneal dialysis; hemodialysis; initiation of dialysis; mineral metabolism; vascular calcification; nutrition; dietary protein intake; dialysate protein losses.

Received 18 December 2006; accepted 2 January 2007.






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