Over the last 25 years, since the introduction of CAPD, the use of PD has increased greatly and over this period many advances in technique have been made. As is well known, that home and self-dialysis, such as PD, cost less than in-center HD and can provide excellent survival and a high level of patient rehabilitation. To date however, the demonstration that PD can provide long term dialysis has been limited to a small number of patients. The next few decades will see a marked increase in the worldwide dialysis population, particularly as older and sicker patients are accepted into dialysis. It is likely that worldwide pressures related to cost containment will favour the use of cost effective therapies, such as PD. However, the increased use of PD will continue, only if we continue to improve its efficacy and do not waste the economic benefits gained over HD. We are challenged to improve and develop PD in a way that optimises patient medical and psychosocial outcomes while minimizing costs. This may be achieved by using more biocompatible solutions, hopefully inexpensive, that will maintain the peritoneal membrane intact for long periods, will better preserve the membrane's transport characteristics over time, and thus reduce the main causes of drop out from dialysis.