A: PD is associated with patient survival advantages when compared with HD during the first 2 years on dialysis.2–9 Unlike saw-tooth treatment with HD, PD delivers a more steady-state treatment, avoiding fluctuations in plasma volume and solutes, and is generally better tolerated by the patients with cardiovascular compromise. PD provides flexible schedules, thus allowing patients to work, travel, and participate in daytime activities. As PD does not involve needlesticks, patient anxiety is mitigated, arteriovenous access sites for future HD are preserved, and the risk of acquiring blood-borne infections such as hepatitis C and HIV are minimized. Additionally, residual renal function (RRF) is better preserved on PD than HD7–13 and is associated with improved outcomes. Furthermore, patients on PD have better long- and short-term transplant outcomes. Recent data suggest that compared with HD, PD patients have significantly lower incidence of delayed graft function, significantly lower requirement of dialysis in the post-transplant period, and better long-term transplant survival.7, 14–16 Moreover, PD is less expensive than HD on a per-patient per-year basis, with the difference estimated to be more than $20,000 based on the 2010 U.S. Renal Data System (USRDS) annual data report.1Despite these advantages and lower costs, the number of patients on PD in the United States has progressively declined over the past 10 years17, 18 to below 7% of the total U.S. dialysis population, compared with other developed countries, where PD is being utilized in a much larger (15-30%) proportion of the dialysis population.1The reasons for low utilization of PD in the United States are complex, but seem to be influenced by psychosocial and economic factors, lack of physician, surgeon, and nursing training, physician bias, and inadequate pre-ESRD education to the patients (Table I). Several of these factors are modifiable, and with a concerted effort PD utilization can be significantly increased.