Development of PD in lower-income countries: a rational solution for the management of AKI and ESKD

Abstract

It is estimated that more than 50% of patients with end stage kidney disease (ESKD) in low-resource countries are unable to access dialysis. When hemodialysis is available, it often has high out of pocket expenditure and is seldom delivered to the standard recommended by international guidelines. Haemodialysis is a high cost intervention with significant negative effects on environmental sustainability, especially in resource poor countries (the ones most likely to be impacted by resultant climate change). This review discusses the rationale for peritoneal dialysis (PD) as a more resource and environmentally efficient treatment with the potential to improve dialysis access, especially to vulnerable populations, including women and children, in lower resource countries. Successful initiatives, such as the Saving Young Lives program, have demonstrated the benefit of PD for acute kidney injury. This can then serve as a foundation for later development of PD services for ESKD programs in these countries. Expansion of PD programs in resource poor countries has proven to be challenging for a variety of reasons. Hopefully, if some of these issues can addressed, PD will be able to permit an expansion of ESKD care in these countries.