Patients initiating dialysis therapy must make a choice between hemodialysis (HD) and peritoneal dialysis (PD). Controversy persists over the relative merits of each modality in the treatment of end-stage renal disease (ESRD). Issues relating to survival, morbidity, economics, and patient characteristics will all determine the final choice of therapy. Non medical factors are the most important determinant of dialysis modality selection. In the United States, HD has been the more commonly used modality, while PD is underrepresented. This disparity arises from multiple factors including reactions (sometimes incorrect) to the healthcare financing structure, physician biases, and changing demographic patterns in the ESRD population. We discuss these issues and present collected evidence showing that increased use of PD may have substantial overall benefit.
The upsurge of new social movements in Latin America has substantially changed the political and social landscape and focussed attention on the hitherto absent voices of these societies. There is a growing interest in the Indian academia towards the continent's recent history as India itself has witnessed an assertion of the marginalised sections of society, evident in the growth of the dalit and women's movements since the 1980s. It is in this context that the Centre for Spanish and Latin American Studies of Jamia Millia Islamia organised a two-day seminar (23-24 March, 2007) on testimonial narratives in India and Latin America under the title: 'Living to Tell their Tale: Testimonio as Subaltern Voice in India and Latin America', which was jointly co-ordinated by Sonya Surabhi Gupta and Vijaya Venkataraman.Testimonio narratives emerged in Latin America in the context of insurgency movements and wars of national liberation during the 1960s and 70s as expressions of cultural resistance, to record the struggles and give voice to the collective experience of the marginalised sections. Hovering at the borders of diverse disciplines like sociology, anthropology, history, ethnography and literature, this hybrid genre was recognised as a literary genre when the prestigious Cuban cultural institution, Casa de las Americas, added an award for this genre to the ones it already had for the genres of the novel, poetry and theatre. The testimonio soon drew attention in academic circles in the context of discussions throughout the 1980s on opening the canon that dominated the metropolitan western and US universities. It has also dominated the debate on issues of race, class and gender, Rigoberta Menchú's I, Rigoberta Menchú: An Indian Woman in Guatemala (1984) being a case in point.
In the early 1960s, peritoneal dialysis (PD) was introduced as a form of long-term maintenance therapy in patients with end-stage renal disease (ESRD). We have come a long way since. Increasing understanding of peritoneal kinetic behavior, its innovative manipulation to meet patient needs, critical monitoring of clinical outcomes, and parallel development in technology have all contributed to the worldwide success of the therapy over the past four decades. In this article we review the evolution of the various PD modalities in the context of these factors.
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