Science and Care in Nephrology: Journey from Prevention to Peritoneal Dialysis

In the management of chronic kidney disease (CKD), there is a large number of patients at risk for renal failure who require renoprotection programs and, at the same time, a much smaller number of patients with end-stage kidney disease who require very costly renal replacement programs. Among the exciting innovations with regard to science and care in nephrology, the areas of prevention and cost-effective quality care of CKD patients using peritoneal dialysis (PD) has seen many new developments, exemplified by work done in the Prince of Wales Hospital in Hong Kong. However, while successes in PD have been achieved, there remain many areas that require further improvement, such as technique failure, prevention and treatment of peritoneal infections, peritoneal access, adequacy of solute removal, peritoneal physiology and changes with long-term PD, patient fatigue, cardiovascular mortality, severe malnutrition, preservation of residual renal function, and metabolic and inflammatory problems. The center in the Prince of Wales Hospital has focused on clinical and basic science research to address these areas, with the aim of making PD a more cost-effective mode of renal replacement therapy with excellent quality. The following areas are highlighted in this review: prevention and treatment of peritonitis, the use of angiotensin-converting enzyme inhibitors in preserving residual renal function, oral bicarbonate in improving acidosis and nutritional status, thiazolidinediones in reducing insulin resistance and inflammation, and the use of biocompatible dialysis solutions in improving peritoneal membrane permeability and reducing inflammation.