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Peritoneal dialysis utilization and outcome: what are we facing?
1Department of Medicine, Tung Wah Hospital, Hong Kong SAR, PR China. wkloc@hkucc.hku.hk
Summary
Peritoneal dialysis (PD) offers comparable survival rates and lower costs than hemodialysis (HD), yet its global use is declining. Addressing physician bias and improving patient education are crucial for increasing PD utilization.
Area of Science:
- Nephrology
- Renal Medicine
- Dialysis Therapies
Background:
- Peritoneal dialysis (PD) utilization shows significant global disparities, with high rates in some regions and declining trends in others.
- Current trends indicate a decrease in PD use in many Western countries despite its benefits.
- Understanding the factors influencing PD adoption is critical for renal care providers.
Purpose of the Study:
- To analyze the global penetration and outcomes of peritoneal dialysis (PD) compared to hemodialysis (HD).
- To highlight the unjustified decline in PD utilization and identify barriers to its adoption.
- To advocate for strategies to overcome negative influences on PD use.
Main Methods:
- Comparative analysis of global PD penetration rates.
- Review of patient survival data for PD versus HD.
- Economic evaluation of PD compared to HD.
- Identification of factors contributing to PD utilization trends.
Main Results:
- PD penetration varies widely worldwide, from over 80% in some countries to a few percent in others.
- PD patient survival is comparable to HD, with faster improvement noted in recent years.
- PD is generally more cost-effective than HD.
- Despite benefits, PD utilization is declining in many developed nations.
Conclusions:
- The declining utilization of PD is not justified by clinical outcomes or cost-effectiveness.
- Addressing physician bias, reimbursement issues, and patient education is essential to reverse negative trends.
- Increased PD use could improve renal replacement therapy accessibility and patient outcomes globally.
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