The process of modality selection and how it works is a critical determinant of peritoneal dialysis (PD) utilization. This very complex process has not been well analyzed. Here, we break it down into 6 steps and point out how problems at each step can significantly reduce the proportion of end-stage renal disease patients initiating PD. It is important that any program wising it to grow its use of PD understand the steps and the points at which problems may be arising. Examples are presented.
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