Life expectancy, expected years of life lost and survival of hemodialysis and peritoneal dialysis patients

End-stage renal disease (ESRD) has been recognized as an emerging clinical problem all over the world. In Tai-wan, the incidence rate increased from 375 per million population (PMP) in 2004 to 404 PMP in 2005, whereas the prevalence rate increased from 1,706 PMP in 2004 to 1,830 PMP in 2005 (1). Under the new policy of cost containment of the National Health Insurance of Taiwan, peritoneal dialysis (PD) has been promoted mainly due to its lower expenditure compared with hemodialysis (HD). PD may also be superior to HD in other aspects. PD pre-serves residual renal function better (2-4) and is associ-ated with higher scores for quality of life (5, 6). In terms of survival, however, the results seem inconsistent. Some studies suggested a survival advantage of PD over HD (7, 8), but others reported that HD patients lived longer than PD patients (9, 10). Similarity in survival was seen in some investigations (11, 12); yet another analysis showed that PD survival was better only at an earlier stage of the dialysis course (13). Although there was a previous study with a big sample size conducted in Taiwan (14), neither that study nor the above-mentioned ones were random-ized clinical trials. As choice of renal replacement therapy often depends on the decision of both patients and medi-cal staff, and thus involves an unavoidable selection bias, more outcome studies with longer follow-up periods are needed to draw any conclusion.Prevention over treatment is not generally practiced. For example, despite the evidence of health benefit from early referral of chronic kidney disease patients to neph-rologist care (15), such practice is limited. As the lifelong costs of renal replacement therapy for ESRD patients are