Peritoneal dialysis: Status report in South and South East Asia

Abstract

Background: Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region. Methods: The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HI & HMI) and low income and lower-middle income (LI & LMI) groups. Results: Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%-7%). But there was a significant difference in per capita income (HI & HMI -US$ 28 129 vs. LI & LMI -US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization. Conclusion: Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.

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

“…Only about 11% of people on dialysis worldwide use chronic PD with >50% living in just four countries—China, the United States of America, Mexico, and Thailand 1,6 . Data from Asia also shows median distribution of PD of 3.4% in LLMICs in Asia compared to 10% in upper‐middle‐ and HICs of Asia 11 . However, data from China showed a massive increase in PD utilization that rose from 8.6% in 2000 to 15.5% in 2012 along with increase in PD centres from <10 to more than 700 in the same period, a policy initiated to improve KRT access at affordable rates 12 .…”

“…1,6 Data from Asia also shows median distribution of PD of 3.4% in LLMICs in Asia compared to 10% in upper-middle-and HICs of Asia. 11 However, data from China showed a massive increase in PD utilization that rose from 8.6% in 2000 to 15.5% in 2012 along with increase in PD centres from <10 to more than 700 in the same period, a policy initiated to improve KRT access at affordable rates. 12 Only a few African countries have PD as an option for KRT despite having some of the lowest availability of KRT across all world regions.…”

Clinical outcomes and performance indicators of patients with kidney failure and acute kidney injuries in ASEAN countries

“…81,82 Lower-and middle-income ASEAN countries had a low PD penetration (less than 5% in the Philippines, Indonesia, Myanmar, Laos and Cambodia), likely due to the lack of formal training/incentives of nephrologists, poor awareness and high costs of maintaining patients on PD. 83 Most perceptibly, this study revealed a lack of transplant activity in the region, which is more evident in lower-and middle-income countries. 21 Transplant penetration (0-18%) paled in comparison with developed countries (United States 29%, United Kingdom 56% and Australia 48%).…”

“…Brunei and Indonesia have initiated the similar PD‐favouring policies to improve their national penetration of this home‐based treatment 81,82 . Lower‐ and middle‐income ASEAN countries had a low PD penetration (less than 5% in the Philippines, Indonesia, Myanmar, Laos and Cambodia), likely due to the lack of formal training/incentives of nephrologists, poor awareness and high costs of maintaining patients on PD 83 . Most perceptibly, this study revealed a lack of transplant activity in the region, which is more evident in lower‐ and middle‐income countries 21 .…”

Practice of dialysis access interventional nephrology procedures in the Asia‐Pacific region: Getting lay of the land

“…Our previous publications were limited to representative countries from South Asia (SA) and South-East Asia (SEA). [10][11][12][13] Here, we report a multinational survey-based study, that collected data from countries from the APR concerning the available dialysis facilities, the ability of a nephrologist to create or treat dysfunctional dialysis access and run training programs. Responses received from 21 countries were provided based on the data available from national disease registries, local and regional studies, or an educated guesstimate of the problem.…”