Dialytic therapy in the management of chronic renal failure

The imperfections of all forms of dialytic therapy leave the nephrologist with the responsibility of recommending to the patient the treatment(s) considered most suitable. This recommendation must take into account the patient's age, home (water supply, sewers, space), social background, occupation, family support, primary renal disease and other medical complications, distance from the medical center, and financial resources. Our impression is that for most medical centers, hemodialysis remains the gold standard for the treatment of end-stage rena; disease and that peritoneal dialysis, intermittent or continuous, is a useful adjunct that should be included in a comprehensive program for back-up care. Furthermore, it is not the type of treatment that will determine the patient's survival and morbidity but rather the risk factors present at the time of initiation of dialytic therapy.