Peritoneal dialysis (PD) is long established as a major option for renal replacement therapy in patients with end-stage renal disease. It is an important part of an integrated service for renal replacement therapy that is frequently selected by patients as their preferred initial mode of therapy and is a therapeutic option for patients wishing or needing to swap from HD and after renal transplant failure.
This guideline is an update of the PD module published on-line on the Renal Association website, www.renal.org in 2007. The English language literature was searched to identify relevant articles on PD published between 2006 and 2010 including:
 Medline search using “peritoneal dialysis” combined with relevant terms
 Cochrane Database of Systematic Reviews
 Review of other national / international PD clinical guidelines
 Identification of further articles quoted in identified papers
The recommendations in this version of the Renal Association Clinical Practice Guidelines for Peritoneal Dialysis guideline have been assessed according to the modified GRADE system. The system was produced by a group of guideline developers and experts in evidence-based medicine. It explicitly describes both the strength of the recommendations and the quality of the underlying evidence, with the aim of maximising applicability to standard clinical practice (1-6). The system grades level of expert recommendation as “strong” (Grade 1) or “weak” (Grade 2) according to balance of benefits, risk, burden and cost. The quality or level of evidence is assessed as “high” (Grade A), “moderate” (Grade B), “low” (Grade C) or “very low” (D) depending on factors such as study design, directness of evidence and consistency of results. The modified GRADE system has been adopted by the Renal Association
Clinical Practice Guidelines Committee and is widely used by a large number of clinical guideline organisations including NICE, SIGN, KDIGO, ERBP, KDOQI, BMJ and WHO (4,7,8). The recommendations in this guideline have been harmonised with other PD guidelines whenever possible and the recommendations to follow international PD guidelines have not been graded