Peritoneal Dialysis in Asia

Abstract

Background: There is a growing demand of dialysis in Asia for end-stage renal failure patients. Diabetes mellitus is the leading cause of end-stage renal failure in many countries in Asia. Summary: The growth of peritoneal dialysis (PD) in Asia is significant and seeing a good trend. With the enhanced practices of PD, the quality of care in PD in Asia is also improved. Overall, PD and hemodialysis (HD) are comparable in clinical outcome. There is a global trend in the reduction of peritonitis rates and Asian countries also witness such improvement. The socio-economic benefits of PD for end-stage renal failure patients in both urban and rural areas in the developed and developing regions of Asia are an important consideration. This can help to reduce the financial burden of renal failure in addressing the growing demand of patients on dialysis. Initiatives should be considered to further drive down the cost of PD in Asia. Key Messages: Growing demand for dialysis by an increasing number of end-stage renal failure patients requires the use of a cost-effective quality dialysis modality. PD is found to be comparable to HD in outcome and quality. In most countries in Asia, PD should be more cost-effective than HD. A ‘PD-first' or a ‘PD as first considered therapy' policy can be an overall strategy in many countries in Asia in managing renal failure patients, taking the examples of Hong Kong and Thailand. Facts from East and West: (1) PD is cheaper than HD and provides a better quality of life worldwide, but its prevalence is significantly lower than that of HD in all countries, with the exception of Hong Kong. Allowing reimbursement of PD but not HD has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over the last years. In the Western world, however, HD is still promoted, and the proportion of patients treated with PD decreases. Japan remains an exception in Asia where PD penetration is very low. Lack of adequate education of practitioners and information of patients might as well be reasons for the low penetration of PD in both the East and West. (2) Patient survival of PD varies between and within countries but is globally similar to HD. (3) Peritonitis remains the main cause of morbidity in PD patients. South Asian countries face specific issues such as high tuberculosis and mycobacterial infections, which are rare in developed Asian and Western countries. The infection rate is affected by climatic and socio-economic factors and is higher in hot, humid and rural areas. (4) Nevertheless, the promotion of a PD-first policy might be beneficial particularly for remote populations in emerging countries where the end-stage renal disease rate is increasing dramatically.

1,25(OH)2D3 treatment attenuates high glucose-induced peritoneal epithelial to mesenchymal transition in mice

“…An earlier study identified that PD accounted for >10% of all forms of renal replacement therapy worldwide in ESRD ( 26 ), however, this has reached 23% in Asia ( 27 ). During PD, the peritoneal mesothelium is usually exposed to hyperglycemic, hyperosmotic and acidic dialysis solutions, which may induce peritoneal fibrosis and eventual lead to PD failure.…”

Towards A Successful Peritoneal Dialysis Program

“…This change is associated with the new bundled payment system, with its clear incentives for peritoneal dialysis [42]. Likewise, allowing reimbursement of PD, but not HD, has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over recent years [42,43]. The major reasons of under utilization of PD modality include (1) lack or inadequate pre-dialysis education [44] and patient's awareness of RRT options [7,44,45], and in particular the suitability and advantages of PD modality, (2) insufficient or lack of focus on patients' training and encouragement and support, especially for anxious and unwell patients who might be nervous about participating in their own treatment [46][47][48], (3) lack or inadequate training of nursing staff and nephrologists in PD therapy [45,49], (4) insufficient encouragement and support of medical and nursing staff to guide patients to chose or implement PD modality as a possible first choice therapy [45,50], (5) lack or insufficient appreciation of the concept of "integrated renal replacement therapy (RRT) program" [1], and (6) inadequate preparation or lack of a proper set up of an independent PD unit [51,52].…”

Education and Protein Supplementation Improve Nutritional Biomarkers among Hypoalbuminemic Peritoneal Dialysis Patients: A Quasi-Experimental Design

“…The annual growth rate of peritoneal dialysis was approximately 8%, exceeding that of hemodialysis (6-7%) [1]. The number of peritoneal dialysis patients in the Asia-Pacific region is significantly increasing each year [1,2]. This happened because peritoneal dialysis is more cost-effective than hemodialysis, which gives patients more freedom over their lives [1,3].…”

“…In addition, the governments allow reimbursement of peritoneal dialysis but not hemodialysis. Moreover, it is comparable in outcome and quality between two therapies [2]. The etiology of protein-energy wasting (PEW) in patients treated with either peritoneal or hemodialysis is comparable, and the prevalence of PEW is relatively high, ranging from 18% to 56% [4][5][6][7].…”