Peritoneal dialysis in India: current status and challenges

Area of Science:

• Nephrology
• Public Health
• Renal Replacement Therapy

Background:

• Chronic peritoneal dialysis (PD) offers an ambulatory, cost-effective renal replacement therapy suitable for resource-limited settings like India.
• Despite its availability for over 15 years, PD adoption in India is hindered by economic constraints, policy gaps, physician bias, and insufficient pre-dialysis patient education.

Purpose of the Study:

• To analyze the challenges and suggest improvements for peritoneal dialysis utilization in India.
• To identify factors contributing to high early dropout rates in PD patients.

Main Methods:

• Review of existing literature and single-center study findings on PD in India.
• Analysis of barriers to PD growth, including economic, policy, and educational factors.

Main Results:

• PD remains underutilized despite its advantages for resource-poor regions.
• High early dropout rates are observed, linked to gram-negative peritonitis, malnutrition, and inadequate dialysis dose escalation.
• Economic factors, policy deficiencies, and lack of pre-dialysis care significantly impede PD expansion.

Conclusions:

• Establishing a national PD registry and enhancing educational initiatives are crucial.
• Integrating PD into comprehensive end-stage kidney disease management strategies can improve its adoption and patient outcomes.