CHRONIC PERITONEAL-DIALYSIS IN SPECIAL SITUATIONS

There are two aspects to considerations of the value of peritoneal dialysis (PD) in the treatment of renal insufficiency with associated pathology. The first involves the effects of the treatment on the symptoms or evolution of the pathology. Examples include the improvement of dyspnea due to cardiac insufficiency (CI) and of cirrhotic ascites (CA). However, there is also an undefined risk of reactivation lupus. The second facet is the increased risk of peritoneal infection, particularly for patients who are HIV + or who are immunosuppressed due to lupus or myeloma. In certain types of case (lupus with intractable vascular thrombosis, intolerance of ultrafiltration in cases of CI, AC or generalised amyloidosis) PD has particular advantages. Nevertheless, there has been no appropriate prospective study to demonstrate or otherwise the advantages in terms of survival. The use of PD remains therefore a matter of choice for individual patients and experienced health care team.