Staff-assisted peritoneal dialysis in the United States: from evidence to national adoption

Staff-assisted peritoneal dialysis (PD) is commonly used in many countries but remains largely unavailable in the United States. This limits access to PD for patients with physical, cognitive, and psycho-social barriers to self-care - the group of patients who may benefit the most from home dialysis. This review explores the global experiences, the limited U.S. implementations, and proposes a pathway for national adoption.

Published reports demonstrate that assisted PD is safe and effective. It is comparable to self-care PD and in-center hemodialysis in outcomes such as peritonitis, hospitalization, and mortality. Assisted PD facilitates PD uptake and retention, thus increasing PD utilization and supporting growth of home dialysis. International models vary in scope, services, and staffing, showing flexibility in design. In the United States, limited programs have demonstrated feasibility. Widespread adoption faces barriers including reimbursement and regulatory challenges. Using the diffusion of innovations lens, assisted PD is still at the "innovator" stage, hindered by perceived complexity, limited trialability, and lack of visibility.

Assisted PD is supported by strong clinical evidence and allows more equitable care. Demonstration projects, standardized templates, supportive reimbursement models, and leadership from nephrology societies and policy makers are critical to help the US nephrology community move from evidence to practice.