 In 1988 I became president of the International Society of Peritoneal Dialysis (ISPD). I was taking over the guide of the Society from the late John F. Maher, a great man and a great friend. In those days, another major change occurred in the life of the Society. The Peritoneal Dialysis Bulletin, born in the late seventies with the sponsorship and support of Travenol Laboratories, became Peritoneal Dialysis International (PDI). Dimitrios G. Oreopoulos, Editor-in-Chief of the Bulletin from the beginning, wrote an editorial entitled "Metamorphosis" in the first issue of PDI. Within the body of the editorial one could read: "except from these editorial changes, Peritoneal Dialysis International will continue in the path pioneered by Peritoneal Dialysis Bulletin, attempting to be the main forum of knowledge and the principal venue for the exchanges of ideas across the broad field of peritoneal dialysis. I have mixed feelings of sadness and pride", wrote Oreopoulos, "like a parent who sees his child coming of age and leaving the house. All of our readers will wish to join me in offering the new PDI their best wishes for a successful journey". In those days, thanks to a generous move of Dimitri, the ISPD acquired the ownership and the copyright of PDI, as it should be in the case of an independent, self-supporting journal willing to become the official voice of a scientific society. That was the case and PDI became the official journal of ISPD. The Society, through the voice of it's President and Council, gave a sincere recognition to Dimitri for his talent and dedication and demonstrated the gratitude of all, appointing him as Editor-in-Chief of the new journal "ad libitum". Now we can say that the journey of PDI has been very successful thanks to the support of ISPD members, the Editorial Board, the huge amount of work dedicated by the Editor-in-Chief and of the support of dialysis and pharmaceuticals companies. I am very happy and proud to have seen our Journal grow progressively and to now reach a very good impact factor and a large popularity among the peritoneal dialysis community. Unfortunately, along the past twenty years, both the growth of ISPD and of PDI have not been followed by the penetration of the technique. Since the early eighties, with the introduction of Continuous Ambulatory Peritoneal Dialysis, we could observe a progressive growth and diffusion of PD around the world, very promising in the first decade but very disappointing in the last twelve years. At present, although PD is worldwide recognized as an established form of renal replacement therapy and the outcome of PD treated patients, within five years from the starting of the treatment, does not show any difference as compared with hemodialysis, the proportion of patients treated by PD fluctuates at around 10% worldwide (12% in Western Europe, 10% in USA ,7% in Japan). This leads to the conclusion that factors other than medical influence the choice of treatment modality, in spite of the fact that the use of PD as first choice treatment offers many financial and logistic advantages. The paradoxical poor penetration of PD depends on many different factors: The most part of dialysis units usually offer only hemodialysis and the private dialysis centers, due to the different reimbursement rate, privilege hemodialysis. ·Many nephrologists, since the introduction of PD, consider PD and HD competitive alternatives and are reluctant to accept the opinion that these two modalities can be complementary and offered as integrated care. The continuous growth of patients necessitating RRT implies an increasing amount of resources, both in term of funds and personnel, hard to finance even for countries with high gross national product. Therefore regulating authorities, nephrologists and scientific societies should carefully review the many advantages offered by PD, mainly with an integrated approach (Peritoneal Dialysis, Hemodialysis and Kidney Transplant). It is noteworthy to underline that PD is easy to perform, is a home dialysis with flexible schedules and low nurse/patient ratio, preserves for a longer time residual renal function, saves the vasculature for future vascular access, needs less erithropoietin, favourably influences the recovery of renal function after cadaveric Kidney Transplantation. At present, I strongly believe that the ideal flowchart for patients who need to start renal replacement therapy is as follows: initiation, when possible with CAPD in order to take advantage, as long as possible, of the residual renal function, increase of the efficiency of PD using home APD, transfer of the patient to extracorporeal modalities when PD cannot guarantee the adequacy of the treatment. To realize such a strategy, educational programs, both for patients with progressive renal failure and for nephrologists, are needed. I take here the opportunity to remind that since 1982, an International Course on Peritoneal Dialysis takes place in Vicenza every three years, with the participation in the faculty of the most outstanding scientists in the field. Furthermore the national nephrological societies should promote the knowledge of the advantages affered by an integrated care of ESRD and invite the regulating authorities to not discriminate PD as the reimbursement policies is concerned. |