How peritoneal dialysis has developed in Vietnam

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Public Health

Background:

• Continuous ambulatory peritoneal dialysis (CAPD) was introduced in Vietnam in 1998 but faced high complication rates (50%), primarily due to catheter issues and peritonitis.
• Initial skepticism and concerns regarding effectiveness and infection risk hindered the slow adoption of CAPD until 2004.
• The country had limited CAPD infrastructure, with only one unit and few patients before 2004.

Purpose of the Study:

• To analyze the evolution and development of CAPD in Vietnam.
• To identify factors contributing to the slow initial adoption and subsequent rapid growth of CAPD.
• To compare the growth trajectory of CAPD with hemodialysis in Vietnam.

Main Methods:

• Retrospective analysis of CAPD implementation and patient data in Vietnam from 1998 to 2007.
• Evaluation of changes in CAPD techniques, including the adoption of the Y-set and two-bag system.
• Assessment of the impact of improved patient selection, training, omentectomy, and insurance coverage on CAPD outcomes.

Main Results:

• Early CAPD (1998) using a straight line and one bag had a 50% complication rate, leading to treatment cessation.
• Implementation of the Y-set and two-bag system, along with omentectomy and enhanced training, significantly reduced complications and improved outcomes after 2004.
• Full insurance coverage for dialysis and erythropoietin since 2005 accelerated CAPD adoption, with patient numbers rising to nearly 700 by 2007, vastly outpacing hemodialysis growth.

Conclusions:

• The adoption of improved CAPD technology (Y-set, two-bag system) and supportive measures (omentectomy, training, insurance) were crucial for overcoming initial challenges in Vietnam.
• CAPD has demonstrated a significantly faster growth rate than hemodialysis in Vietnam since 2004.
• Further advancements like automated PD and icodextrin are not yet available in Vietnam but could offer future potential.