Peritoneal dialysis (PD) is acknowledged worldwide as a well-accepted form of renal replacement therapy (RRT) for end-stage renal disease (ESRD). Ideally, PD should be the preferred modality of RRT for ESRD in developing countries due to its many inherent advantages. Some of these are cost savings (especially if PD fluids are manufactured locally or in a neighboring country), superior rehabilitation and quality of life (QOL), home-based therapy even in rural settings, avoidance of hospital based treatment and the need for expensive machinery, and freedom from serious infections (hepatitis B and C). However, this is not the ground reality, due to certain preconceived notions of the health care givers and governmental agencies in these countries. With an inexplicable stagnation or decline of PD numbers in the developed world, the future of PD will depend on its popularization in Latin America and in Asia especially countries such as China and India, with a combined population of 2.5 billion and the two fastest growing economies worldwide. A holistic approach to tackle the issues in the developing countries, which may vary from region to region, is critical in popularizing PD and establishing PD as the first-choice RRT for ESRD. At our center, we have been pursuing a 'PD first' policy and promoting PD as the therapy of choice for various situations in the management of renal failure. We use certain novel strategies, which we hope can help PD centers in other developing countries working under similar constraints. The success of a PD program depends on a multitude of factors that are interlinked and inseparable. Each program needs to identify its strengths, special circumstances, and deficiencies, and then to strategize accordingly. Ultimately, teamwork is the 'mantra' for a successful outcome, the patient being central to all endeavors. A belief and a passion for PD are the fountainhead and cornerstone on which to build a quality PD program.

In a peritoneal dialysis (PD) program, an efficient and well-structured home visit schedule is imperative for ensuring patient compliance, adherence to proper exchange technique, nutrition status monitoring and intervention, and early detection of evolving medical co-morbid problems so as to prevent further complications. Regular home-visit follow-up of the PD patient directly affects technique survival and quality of life. The clinical coordinator is ideally placed to be the direct link between the PD center and patients in their domiciliary surroundings. This professional plays a crucial role in the success of a PD program.

PD can bridge this gap and can serve as a first line of therapy if it becomes more affordable. Government reimbursement schemes, the Once-in-a-Lifetime Payment Scheme, and PD insurance all provide strong impetus to dialysis programmes. Local manufacturing of PD fluid has also reduced the cost of therapy to some extent. PD may be preferable for patients with cardiovascular morbidity and it also obviates the risk of transmission of blood-borne diseases such as HIV, hepatitis B, and hepatitis C. In our own centre, automated PD is being used as initial RRT for acute kidney injury with good results. In prospective transplant recipients, PD has been found to decrease the risk of posttransplant graft dysfunction. Key Messages: Remote PD and home visits by PD clinical coordinators have brought faraway patients and their nephrologists closer with the use of technology. For these reasons, the current pressing need is to bring PD to the forefront of RRT in resource-poor countries in South Asia to enable universal treatment of patients with renal disease.

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