Peritoneal dialysis-first policy made successful: perspectives and actions

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Public Health Policy

Background:

• Peritoneal dialysis (PD) is an underutilized renal replacement therapy globally.
• Barriers to PD adoption include lack of expertise and pragmatic strategies.
• A PD-first initiative in Hong Kong over 25 years ago provides a case study.

Purpose of the Study:

• To review the evidence supporting PD as a beneficial dialysis strategy.
• To discuss the implementation of a PD-first policy, highlighting successes and challenges.
• To identify key elements for successful PD program development.

Main Methods:

• Review of clinical studies and research on PD outcomes.
• Analysis of a long-standing PD-first initiative.
• Discussion of factors influencing PD policy implementation.

Main Results:

• PD improves patient survival, preserves residual kidney function, reduces infection risk, and enhances patient satisfaction.
• PD offers financial benefits to healthcare systems by managing end-stage renal disease.
• Key success factors include nephrologist expertise, PD catheter access, and patient/caregiver training and support.

Conclusions:

• A PD-first approach can significantly benefit patients and healthcare systems.
• Successful implementation requires addressing patient factors, technical aspects, and policy incentives.
• Nephrologist expertise, catheter access, and psychosocial support are crucial for PD program success.