Practical Use of Peritoneal Dialysis

Abstract

The modern era of clinical peritoneal dialysis started in 1959 with the introduction of the single catheter method and of commercially prepared dialysis solution (1). Peritoneal dialysis then became an established method for the treatment of acute renal failure, but many clinicians were reluctant to use it despite its technical simplicity, because of a high incidence of associated peritonitis, a lower efficacy in comparison with haemodialysis and the rather high cost of commercially prepared dialysis solutions. From 1961 to 1972, these shortcomings were partly overcome due to many conceptual and technological advances including: a better understanding of solute peritoneal transfer kinetics which gave a rational basis for improving peritoneal clearances (2, 3); the development of automated closed circuit dialysate delivery systems which strikingly reduced the incidence of peritoneal infection (4); the introduction of a bacteriologically safe peritoneal access device which eliminated the difficulties and hazards of the repeated puncture technique (5); and finally simplified logistics and reduced costs which were obtained when the reverse osmosis machines became available for the continuous production of sterile, apyrogenic dialysis fluid at the bedside (6).