Patient Candidacy

Prioritize PD for the majority of ESKD patients


At least 78% of patients have no absolute medical or social contraindication for PD1,2

This includes diabetic, elderly & obese patients who are often excluded from PD3-6

Data suggests that Diabetic, Elderly and Obese patients may do well on PD7-9

Diabetic patient icon

Diabetic Patients

Data shows overall patient survival was significantly higher compared  with PD than HD in incident dialysis patients with diabetes10

Elderly patient icon

Elderly Patients

Older patients reported significantly better kidney disease-specific quality of life compared to younger patients9

Obese patient icon

Obese Patients

Single-center retrospective cohort study, obesity also conferred a survival advantage in their PD population compared to non-obese patients7

Evidence shows that patients with diabetes may do well on PD8,11,12

Based on the review of nine mortality studies comparing PD and HD12:

Among younger patients without and with diabetes in the United States, Canada, and Denmark, PD is associated with survival equivalent to or better than that for HD12

In patients with diabetes over 45 years of age, there is no survival benefit for those on HD vs PD, although in the US, HD is associated with better survival12

Diabetes, age, and comorbidity all significantly modify the effect of treatment modality on patient survival*12

*Data analysis (as-treat and intent to treat) also modifies the effect of treatment modality on patient survival  

“Regardless of the reported differences in mortality between diabetics on PD and HD, the early initiation of an adequate chronic PD program may ensure higher long-term outcome in PD diabetic patients.”11 

Passadakis PS, Oreopoulos DG. Diabetic patients on peritoneal dialysis. Semin Dial. 2010;23(2):191-197.

Diabetic patients should be considered for PD

Survival of patients from a Korean cohort study, comparing mortality risk in diabetic PD and HD matched for glycemic control10

Chart showing survival of patients from a Korean cohort study

Kaplan–Meier analysis of all-cause mortality according to dialysis modality in the (A) whole cohort of 902 patients and (B) 773 patients who had available HbA1c.

Patients treated with HD showed significantly higher all-cause mortality than those with PD in the whole cohort (log-rank test, P = 0.009) and in 773 patients (log-rank test, P = 0.012). HbA1c = hemoglobin A1c, HD = hemodialysis, PD = peritoneal dialysis.

Adapted from Lee MJ  et al. Medicine (Baltimore). 2016; 95(11): e3118.

The authors’ conclusion states  
“…the overall patient survival of PD was significantly higher compared with that of HD in incident dialysis patients with diabetes. In addition, better patient survival with PD was influenced by the degree of glycemic control.”10

Lee MJ et al. Medicine (Baltimore). 2016; 95(11): e3118

Chart showing comparison of good and poor control of sugar

In patients with good glycemic control (HbA1c <8%), the cumulative survival rate was significantly higher in patients on PD than in patients on HD (P=0.021). 

However, there was no statistically significant difference in survival in patients with poor glycemic control (HbA1c ≥8%). 

  1. Diabetics with good glycemic control do better on PD than on HD
  2. Those with poor glycemic control do as well on PD as on HD

Elderly patients should be considered for PD

Average age of patients on PD in the US is increasing13

Chart showing the average age of patients on PD in the US is increasing
Adapted from 2018 USRDS Annual Data Report Reference Tables, Table D.8, Counts of point prevalent ESRD patients, by mode of therapy: peritoneal dialysis

Given the recent outcome data of PD versus HD, older data showing worse outcomes on PD are no longer relevant17,18

Elderly patients with end-stage renal disease are appropriate candidates for peritoneal dialysis 

  • Most elderly patients possess the manual and cognitive skills necessary to perform PD14
  • Elderly patients on PD exhibit excellent compliance with their treatment regimen and display no increase in the rate of infectious complications, though they may have a slight increase in hospital days14. These patients:
    • Easily achieve adequacy targets
    • Experience good technique survival
    • Have nutritional status that is at least as good as that of their hemodialysis counterparts14
  • Patient survival varies around the world but is overall comparable to that of age-matched patients on hemodialysis14
  • Quality of life may be somewhat superior to that of older hemodialysis patients14

It is not medically justifiable to exclude them from consideration for this therapeutic modality14

Table 2 Mean (SD) of QoL and Emotional distress outcomes by Age Group
Adapted from Griva K, et al. J Adv Nurs. 2014;70(8):1902-1914.
*Statistically significant in ANOVA tests. †Statistically significant when analyses were repeated using ANCOVA tests with adjustment for case-mix differences. KDQOL-SF, Kidney Disease Quality of Life Short Form; SF-12, 12-item Short-Form Health Survey; PCS, physical component summary score; MCS, mental component summary score; KDCS, kidney disease component summary score; WHOQOL-BREF, World Health Organization Quality of Life Instrument, Short Form; QoL, quality of life; HADS= Hospital Anxiety and Depression Scale.

Clinical advice on PD and the elderly patient15

KDIGO in collaboration with the European Renal Best Practice (ERBP) Advisory Board issued clinical advice which states:

“Older age should not be considered a contra-indication for PD”

KDIGO in collaboration with the European Renal Best Practice (ERBP) Advisory Board

Obese patients should be considered for PD

Overweight and obese peritoneal dialysis patients have longer survival than those with lower BMI – a difference that is not adequately explained by lower transplantation and technique survival rates.7 

“It is impossible to prove, but tempting to speculate, that overweight patients receive narrower treatment choices than those with normal BMI. If such a bias exists, it appears to be in direct contradiction to survival estimates.”7

Snyder JJ, et al. Body size and outcomes on peritoneal dialysis in the United States. Kidney Int. 2003;64(5):1838-1844.

A single-center observational study, obesity also conferred a significant survival advantage in their PD population16

“Obese patients should therefore not be discouraged from receiving PD purely on the basis of BMI.”16

Johnson DW, et al. Is obesity a favorable prognostic factor in peritoneal dialysis patients? Perit Dial Int. 2000;20(6):715-721.

Screen showing Program Overview webpage

Explore the evidence with our PD Candidacy Resource Guide on our PD Management Tools page