Is there a survival advantage in Asian peritoneal dialysis patients?

Over the last decade, epidemiological surveys and qualitative research literature have demonstrated and validated a better survival in the Asian peritoneal dialysis population. This review summarizes the current understanding of Asian peritoneal dialysis patient survival and attempts to scrutinize the supposed survival advantage of this population group. We outlined the published peritoneal dialysis survival data from a literature search, with reference to dialysis patient cohorts from 1983 through 2002 for prevalent cases and 1980 through 2002 for incident patients. Two-year and 5-year patient survival rates in excess of 80% and 60% respectively were demonstrated in Asian countries, which compared favorably with the CANUSA, ADEMEX and most Caucasian series. Better end-stage renal disease patient survival is apparent despite a dialysis adequacy disadvantage, for reasons yet to be identified. As is the case of other racial disparities in medical care, such a difference is a product of more than biological differences and include budgetary barrier, health care system and geographic variation, physician bias and statistical pitfalls. Particular efforts should therefore be made to explore the underlying reason(s) for the Asian peritoneal dialysis patient survival advantage. Alternative approach and guidelines to peritoneal dialysis delivery in Asia might be warranted.