1. Outcome of patients started on PD as first line therapy, Saira Usama, Jamal S. Alwakeel, Ahmad H. Mitwalli, Abdulkareem Alsuwaida, Akram Askar, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia Outcome of patients started on PD as first line therapy, Saira Usama, Jamal S. Alwakeel, Ahmad H. Mitwalli, Abdulkareem Alsuwaida, Akram Askar, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia Background References Objectives This research was supported by King Saud University, Riyadh, Saudi Arabia To assess complications and outcome of patients started on peritoneal dialysis (PD) as initial dialysis therapy, compared to PD after Hemodialysis (HD). Conclusion Results  125 patients followed in the peritoneal dialysis unit at King Khalid University Hospital, Riyadh, Saudi Arabia  during a 10 year period, between 2002 and 2011.  86 patients (M:F ratio, 41:45) were started on PD as the initial dialysis therapy. Mean age was 43.4 (16 – 82 ± 19.3) years  39 patients ( M:F 15:24) were shifted to PD after having received regular Hemodialysis (POST HD). Mean age of the patients was 62.2 (21 – 86 ± 16.9) years. Methods Causes of ESRD in both groups (percentage) The major goals in caring for patients with end stage renal disease are to improve morbidity and mortality improve quality of life preserving residual renal function, and reducing morbidity. The experience of many centers worldwide have shown good results with peritoneal dialysis (PD)as first line therapy, due to its simplicity, convenience, and low cost. The mean time on PD was 31.83 (2 – 168 ±30.197) months in the PD group, and 28.37 (2 – 92) months in the post HD group. The mortality in PD group was 13.9% (12 patients) and 25.64 % (10 patients) in the post HD group. In PD group, 22.1% (19 patients) were shifted to HD, due to technique failure compared to 35.9% (21 patients) in the post HD group. 16.27 % (14 patients) underwent renal transplant in PD group as compared to 5.1% (2 patients) in post HD group. 4 patients were transferred to another center, in each group. In PD group, 41.86% (36 patients) were continuing on PD at the end of the study compared to 23.08 % (9 patients) in the post HD group. In PD group, the peritonitis rate was one episode every 51.94 patient months and 1 episode every 33.78 patient months in the post HD group Over a ten year period, patients started on renal replacement therapy with PD showed a better patient and technique survival compared to patients initially on HD The patients in the PD group had longer time on PD ( p= 0.008), lower mortality(p= 0.01) fewer peritonitis episodes (p= 0.027). However this can be attributed to differences in age and sample size. PD as the first-choice modality for renal replacement therapy has been shown to be beneficial in many studies (1), with results similar to our study  A study by R Vanholder et al (2), showed that PD as first line therapy has the advantage of preservation of residual renal function, and lower mortality rates  Pierre-Yves Durand, et al reported improved patient survival compared with HD patients during first 2 years of dialysis (3). PD utilization can be increased by implementing techniques to prevent and minimize episodes of peritonitis, use of more biocompatible solutions in preserving the peritoneal membrane, and careful management of volume status (4,5). Patient and physician education and comfort with using this modality are critical in the success of initiative of PD first. Discussion 1.Yiu-Wing Ho, Ka-Foon Chau, Development of the “peritoneal dialysis first” model in hong kong Perit Dial Int June 2007 27:S53-S55 2.R Vanholder, W Van Biesen, N Lameire The role of peritoneal dialysis as the first-line renal replacement modality Perit Dial Int 2000 Jul-Aug 20:375-383 3.Pierre-Yves Durand, Luc Frimat, Carole Loos-Ayav, Impact Of First Dialysis Modality On Outcome Of Patients Contraindicated For Kidney Transplant Perit Dial Int March/April 2006 26:231-239 4.Shahab I, Khanna R, Nolph KD Peritoneal dialysis or hemodialysis? A dilemma for the nephrologist.Adv Perit Dial. 2006;22:180-5. 5.Wai-Kei LoPeritoneal dialysis utilization and outcome: what are we facing? Perit Dial Int. 2007 Jun;27 Suppl 2:S42-7Perit Dial Int.