Abstract
Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe. A cross-sectional survey. Stakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September2018. PD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures. Descriptive statistics. Responses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes. Low responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data. Large inter- and intraregional disparities exist in PD availability, accessibility, affordability, delivery, and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia.
Highlights
The number of people with kidney failure is growing; without kidney replacement therapy (KRT), these people face death from kidney failure.[1]
peritoneal dialysis (PD) Use Information on the use of PD was available from 110 countries (Table 1)
PD use was highest in HIC (53pmp) followed by UMIC (26.5pmp), LMIC (5.8pmp) and LIC (0.9pmp)
Summary
The number of people with kidney failure is growing; without kidney replacement therapy (KRT), these people face death from kidney failure.[1] Each year, approximately 5–10 million people die due to a lack of access to dialysis for treatment of kidney failure or acute kidney injury.[2,3] Data published recently in the second Global Kidney Health Atlas (GKHA) commissioned by the International Society of Nephrology (ISN) revealed extraordinary disparities in the provision of KRT (dialysis or kidney transplantation) around the world.[4,5,6,7,8,9] Patients living in low-income countries typically confront the most barriers to KRT access; often, these challenges are exacerbated by the need to contribute personal funds for dialysis treatment.[5,8] Residents of remote communities with limited access to facilities that provide nephrology care must overcome significant barriers to access treatment.[4] Within these challenging contexts, peritoneal dialysis (PD) may serve as an ideal KRT modality relative to hemodialysis. The present study is part of the second iteration of the GKHA survey and examines the availability, accessibility, affordability and reporting of quality outcome measures of PD worldwide
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