Does residual renal function decline more rapidly in hemodialysis than in peritoneal dialysis? How good is the evidence?

Residual renal function (RRF) is an important determinant of survival on dialysis. Preservation of RRF is also important for lowering comorbidity and improving quality of life. Initiation of dialysis is associated with gradual loss of RRF over time. As compared with hemodialysis, peritoneal dialysis is reported to be associated with a slower decline of RRF. Also, RRF depends on several factors that may affect its decline independent of dialysis. The analysis of RRF decline on dialysis is therefore complex. The present article examines the issues in detail and provides evidence if one form of dialysis is superior to the other in preserving RRF.