Criteria for selection of ESRD treatment modalities

The most important renal replacement therapies (RRT) for end-stage renal disease (ESRD) patients are hemodialysis (HD), peritoneal dialysis (PD) and renal transplantation (RT). Survival, morbidity and quality of life are the main factors to select the best RRT modality for a particular patient. The outcome comparison suggest that RT is a better overall treatment for ESRD patients. On the other hand, the studies that compared patient outcome for HD and PD have yielded conflicting results. Neither treatment modality is best suited for all patients. The choice should be analyzed for each particular patient considering his demographic and comorbid conditions. Diabetic patients, patients with cardiovascular disease and elderly patients are high risk populations and they are discussed independently. The frequency of treatment modalities in the different countries is not in accordance with the analysis of the advantages and disadvantages of each one. Non-medical reasons are important factors in dialysis modality selection. In our experience the expertise of the nephrologic team is the most important one. RT, HD and PD should not be seen as competing therapeutic options, rather, they are complementary methods of dealing with uremia. An integrated approach combining HD, PD and RT is necessary to devise an individualized treatment program permitting optimal long-term physical and psychological well being and adequate integration in the family and society.