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Changes in the worldwide epidemiology of peritoneal dialysis
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Journal Article
Changes in the worldwide epidemiology of peritoneal dialysis
2017
Overview
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
In many countries, patient outcomes with peritoneal dialysis are comparable or superior to those with haemodialysis. Here, the authors discuss the changing epidemiology of peritoneal dialysis worldwide, including the remaining country-specific challenges that must be overcome to improve utilization of this cost-effective therapy.
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.
Publisher
Nature Publishing Group UK,Nature Publishing Group
