APD in the developing world: is there a future?

Automated peritoneal dialysis (APD) has experienced significant growth in highly developed nations in the last few years, while in developing countries with important social, educational, and financial constraints this treatment modality is, at best, trying to emerge. APD offers advantages that make it popular. Some of these advantages include increased adequacy for some patient groups, enhanced patient well-being and positive changes in lifestyle, as well as a reduction in peritonitis rates attributed to fewer connect-disconnect procedures. The development of APD in developing nations has been very poor mainly due to educational and financial constraints. APD growth as a treatment modality in the developing world requires multiple approaches, some of them general and others related to the specific needs of each nation. There is a need to develop APD research projects and pilot programs to demonstrate the benefits for specific subpopulations. In addition, the development of research and industry-market strategies directed at reducing costs related to this form of treatment are required. The relatively low use of APD in developing nations is primarily influenced by nonmedical factors. Given the financial and educational constraints, APD programs may need to be directed toward specific subpopulations such as young working adults, individuals who require assistance to perform procedures, or patients who require an increased dialysis dose in order to reach adequate clearances.