Around the world there is a trend to see PD prevalence is on the rise in both developing and developed world. Hong Kong has always been a PD first model for many years. But we are seeing the reimbursement system in USA, Thailand and China are all favouring PD. These all point to PD being a cost-effective quality dialysis modality for end stage renal failure patients. So such a general growth for PD also calls for bigger need for education, training and standards that would push the quality of PD care to a higher level. At the same time that PD and HD have comparable outcomes and patient survival, there are clinical challenges of peritoneal dialysis. These include: peritoneal infections, malnutrition & inflammation, cardiovascular mortality, volume overload, glucose exposure, peritoneal access, adequacy of solute removal, peritoneal physiology and changes with long term PD and patient fatigue. Peritoneal infections are always being regarded as a major challenge to push back clinicians and patients to use PD as their modality of treatment for end stage renal failure. The ISPD guidelines on prevention and treatment of peritonitis updated in 2016 has provided a good reference for managing such patients. It is gratifying to see an improvement around the world is the gradual improvement in PD related peritonitis in recent years. However, the upcoming of a lot of resistant organisms in peritonitis is an area of concern and do need attention. We are seeing more innovations in terms of diagnosis, predicting treatment failure and relapse as well as the use of newer antibiotics. The use of artificial intelligence and also point of care tests in the area of diagnosis of PD peritonitis may enhance its overall management in the near future. 1. Li PKT, et al. ISPD peritonitis recommendations: 2016 update on prevention and treatment. Perit Dial Int 2016; 36(5): 481-508 LI PKT, et al. Current Challenges and Opportunities in PD. Seminars in Nephrology 2017 Jan;37(1):2-9 Li PKT, et al. Changes in the worldwide epidemiology of peritoneal dialysis. Nature Reviews Nephrology 2017 Feb;13(2):90-103 LI PKT, et al. Inflammation and Peritoneal Dialysis. Seminars in Nephrology 2017 Jan;37(1):54-65 Li PK, et al. Tackling Dialysis Burden around the World: A Global Challenge. Kidney Dis (Basel) 2021 May;7(3):167-175.