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American Journal of Kidney Diseases

Peritoneal Dialysis–First Policy Made Successful: Perspectives and Actions

  • Philip Kam-tao Li
    Correspondence
    Address correspondence to Philip Kam-tao Li, MD, FRCP, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
    Affiliations
    Division of Nephrology, Carol and Richard Yu PD Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
    Search for articles by this author
  • Kai Ming Chow
    Affiliations
    Division of Nephrology, Carol and Richard Yu PD Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
    Search for articles by this author
      Peritoneal dialysis (PD) represents an important but underused strategy for patients who are beginning dialysis treatment worldwide. The development of a health care model that encourages increased use of PD is hampered by a lack of expertise and absence of pragmatic strategies. This article provides a brief review of a PD-first initiative that was implemented in Hong Kong more than 25 years ago and issues related to this policy. Clinical studies and research by the authors' and other teams around the world have shown evidence that, as a home-based dialysis therapy, PD can improve patient survival, retain residual kidney function, lower infection risk, and increase patient satisfaction while reducing financial stress to governments by addressing the burden of managing the growing number of patients with end-stage renal disease. Achieving a successful PD-first policy requires understanding inherent patient factors, selecting patients carefully, and improving technique-related factors by training physicians, nurses, patients, and caregivers better. Dialysis centers have the important role of fostering expertise and experience in PD patient management. Dialysis reimbursement policy also can be helpful in providing sufficient incentives for choosing PD. However, despite successes in improving patient survival, PD treatment has limitations, notably the shortcoming of technique failure. Potential strategies to and challenges of implementing a PD-first policy globally are discussed in this review. We highlight 3 important elements of a successful PD-first program: nephrologist experience and expertise, peritoneal dialysis catheter access, and psychosocial support for PD patients.

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