Various reasons for “Peritoneal Dialysis (PD) First” rather than hemodialysis (HD) have been presented, such as better preservation of residual renal function (RRF), longer survival, and lower incidence of hospitalization. In spite of these advantages for “PD First”, in Japan as well as in the United States the annual rate of patients receiving PD has been reduced to less than 10%. One of the major reasons against selecting PD is that a large proportion of PD patients are transferred from PD to HD in less than 5 years. Our “PD First” policy is based on the diversity of modalities available after discontinuing PD therapy.