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The case for increased peritoneal dialysis utilization in low- and lower-middle-income countries

Ikechi G Okpechi1,2,3, Vivekanand Jha4,5,6, Yeoungjee Cho7,8,9

  • 1Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.

Nephrology (Carlton, Vic.)
|January 21, 2022
PubMed

Insights

Peritoneal dialysis (PD) is underutilized globally, especially in low-income countries, despite its advantages. This review challenges the inevitability of low PD use by exploring unique barriers and presenting opportunities for improvement.

Area of Science:

  • Nephrology
  • Public Health
  • Global Health

Background:

  • Peritoneal dialysis (PD) offers advantages over hemodialysis (HD) but is globally underutilized, particularly in low- and lower-middle-income countries (LLMICs).
  • Current PD use is only 11% worldwide, with over half concentrated in a few high-income nations.
  • Barriers include patient preference, education, reimbursement, and unique challenges in LLMICs like high costs and inadequate training.

Purpose of the Study:

  • To identify and discuss barriers to increased peritoneal dialysis utilization in LLMICs.
  • To challenge the notion that low PD use in LLMICs is unavoidable.
  • To present opportunities for improving PD uptake in resource-limited settings.

Main Methods:

  • Review of existing literature on PD utilization and barriers.
  • Analysis of global trends in PD-related infections, modality switches, and patient survival.
  • Discussion of specific challenges and potential solutions for LLMICs.

Main Results:

  • Global trends show decreasing PD-related infections and improved patient survival.
  • Modality switches from PD to HD are also decreasing globally.
  • Despite significant barriers in LLMICs, PD remains a viable and potentially underused kidney replacement therapy.

Conclusions:

  • Low PD utilization in LLMICs is not unavoidable and can be addressed by overcoming specific barriers.
  • Leveraging global positive trends in PD outcomes can encourage wider adoption.
  • Strategic interventions are needed to increase access and utilization of PD in resource-limited settings.

Keywords:
chronic kidney diseasecostkidney outcomeskidney replacement therapieslow-income and lower-middle-income countriesperitoneal dialysis

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