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Peritoneal Dialysis Use and Practice Patterns: An International Survey Study
Yeoungjee Cho1, Aminu K Bello2, Adeera Levin3
1Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia; Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia.
Insights
Global disparities in peritoneal dialysis (PD) access and quality are significant. This study highlights major gaps in PD availability, affordability, and outcome reporting, particularly in Africa and South Asia, impacting kidney failure patients worldwide.
Area of Science:
- Nephrology
- Global Health
- Dialysis Therapy
Background:
- Peritoneal dialysis (PD) is a vital treatment for kidney failure, used by approximately 11% of patients globally.
- Significant regional variations in PD utilization and practice patterns necessitate a comprehensive worldwide assessment.
Purpose of the Study:
- To investigate the global landscape of peritoneal dialysis (PD) use, availability, accessibility, and affordability.
- To examine the delivery of PD and the reporting of quality outcome measures across diverse countries.
Main Methods:
- A global cross-sectional survey was conducted involving stakeholders from 182 countries.
- Data were collected on PD use, availability, cost, delivery, and quality metrics, with responses received from 88% of countries.
Main Results:
- Peritoneal dialysis (PD) was unavailable in 19% of responding countries, with higher rates in Africa and low-income nations.
- Significant disparities were found in PD accessibility, affordability (patient copayments), and adequate exchange volumes.
- Quality outcome monitoring and reporting for PD were variable, with most countries not measuring patient-reported outcomes.
Conclusions:
- Substantial inter- and intraregional disparities exist in peritoneal dialysis (PD) provision and quality worldwide.
- The greatest deficits in PD availability, accessibility, affordability, and quality reporting were observed in Africa and South Asia.
- Addressing these disparities is crucial for equitable kidney failure management globally.
Rationale & Objective:
Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.
Study Design:
A cross-sectional survey.
Setting & Participants:
Stakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018.
Outcomes:
PD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures.
Analytical Approach:
Descriptive statistics.
Results:
Responses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.
Limitations:
Low responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.
Conclusions:
Large inter- and intraregional disparities exist in PD availability, accessibility, affordability, delivery, and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia.
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