Modality selection.

Abstract

Dialysis modality selection should be based on patient preference and medical indications. Every effort should be made to provide adequate dosing of dialysis by using guidelines supported by clinical outcome evidence. All patients should receive explicit information on all modalities of therapy, including transplantation, in a balanced presentation before initiation of dialysis. The patient should be an active participant in the selection process. The advantages, disadvantages, indications, and contraindications for hemodialysis and the various modalities of peritoneal dialysis are reviewed in light of the state of the art knowledge. Further research is critical to answer three unresolved issues: (1) What are the equivalent doses for peritoneal dialysis and hemodialysis? (2) Are dialytic and renal clearances equivalent? and (3) Will survival improve by providing peritoneal dialysis doses above those currently recommended?