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Changes in the worldwide epidemiology of peritoneal dialysis

Key Points

  • Peritoneal dialysis is a high quality and cost-effective dialysis modality

  • In the past decade the greatest increases in peritoneal dialysis utilization have occurred in China, Thailand and the USA; peritoneal dialysis utilization has decreased in parts of Europe and in Oceania

  • Asia has experienced the largest absolute growth in patients on dialysis, and is characterized by the largest regional variation in peritoneal dialysis utilization

  • Reimbursement schemes and government policy are important determinants of peritoneal dialysis epidemiology

  • Peritoneal dialysis first policies (Hong Kong and Thailand), the peritoneal dialysis favoured policy (China) and the home dialysis first model (Australia and New Zealand) have resulted in increased utilization of peritoneal dialysis

  • Major challenges to increased utilization of peritoneal dialysis — particularly in developing countries — include prohibitive costs, lack of trained medical personnel, disparities in health-care provision and a lack of infrastructure

Abstract

As the global burden of chronic kidney disease continues to increase, so does the need for a cost-effective renal replacement therapy. In many countries, patient outcomes with peritoneal dialysis are comparable to or better than those with haemodialysis, and peritoneal dialysis is also more cost-effective. These benefits have not, however, always led to increased utilization of peritoneal dialysis. Use of this therapy is increasing in some countries, including China, the USA and Thailand, but has proportionally decreased in parts of Europe and in Japan. The variable trends in peritoneal dialysis use reflect the multiple challenges in prescribing this therapy to patients. Key strategies for facilitating peritoneal dialysis utilization include implementation of policies and incentives that favour this modality, enabling the appropriate production and supply of peritoneal dialysis fluid at a low cost, and appropriate training for nephrologists to enable increased utilization of the therapy and to ensure that rates of technique failure continue to decline. Further growth in peritoneal dialysis use is required to enable this modality to become an integral part of renal replacement therapy programmes worldwide.

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Figure 1: Patient, facility, health-care system and industry factors that can influence the recruitment and retention of patients on peritoneal dialysis.
Figure 2: Trends in the prevalence of patients on peritoneal dialysis in Asia between 1999 and 2013.
Figure 3: Factors that could improve access to and expertise in peritoneal dialysis.

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Authors

Contributions

All authors researched the data for the article, made a substantial contribution to discussion of the content, wrote the article and reviewed or edited the manuscript before submission.

Corresponding author

Correspondence to Philip Kam-Tao Li.

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Competing interests

P.K.-T.L. is the Immediate Past President of the International Society for Peritoneal Dialysis (ISPD). D.W.J. is the President Elect of ISPD and has received consultancy fees, research grants, speaker's honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care. K.J.J. has received speaker's honoraria from Fresenius Medical Care. R.M. is the Treasurer of ISPD. S.N. chairs the Award Committee of ISPD. R.P.F. has received research grants from Baxter Healthcare and Fresenius Medical Care. X.Q.Y. chairs the Membership Committee of ISPD and has received consultancy fees, research grants, speaker's honoraria and travel sponsorships from Baxter Healthcare and speaker's honoraria and travel sponsorships from Fresenius Medical Care. K.M.C., M.W.M.V.L. and N.L. declare no competing interests.

Supplementary information

Supplementary information S1 (table)

Epidemiology of peritoneal dialysis in Australia and New Zealand 2003–2013 (PDF 115 kb)

Supplementary information S2 (figure)

Trends in the incidence and prevalence of renal replacement therapy modalities at day 91 during 2005–2012 in Europe* (PDF 113 kb)

Supplementary information S3 (figure)

5-year survival of patients starting dialysis in Europe between 2005 and 2007 (PDF 121 kb)

Supplementary information S4 (figure)

The prevalence of patients with end-stage renal disease undergoing PD in the USA from 2003 through 2012. (PDF 93 kb)

PowerPoint slides

Glossary

Continuous ambulatory peritoneal dialysis

A continuous renal replacement therapy process in which solutes and fluid are exchanged between blood in the peritoneal capillaries and dialysis solution in the peritoneal cavity by crossing the peritoneal membrane. Patients usually perform 3–4 manual exchanges per day.

Technique survival

The likelihood of remaining on peritoneal dialysis. Technique failure is generally defined as any peritoneal-dialysis-related complication that leads to permanent cessation of the therapy (including peritoneal dialysis-related death), and less commonly a switch to haemodialysis for a period of at least 1 month.

Home dialysis first model

A model of care in which home dialysis is the default option for patients who require renal replacement therapy. Rather than assessing a patient's suitability for home dialysis, patients are assumed to be appropriate for this modality before the application of any exclusion criteria.

Automated peritoneal dialysis

A peritoneal dialysis modality in which an automated cycler is programmed to perform multiple exchanges overnight. To enable peritoneal dialysis in the daytime, the cycler can be programed to perform a final fill before the patient disconnects in the morning.

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Li, PT., Chow, K., Van de Luijtgaarden, M. et al. Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol 13, 90–103 (2017). https://doi.org/10.1038/nrneph.2016.181

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