Why less success of the peritoneal dialysis programmes in Europe?

Abstract

In this issue of NDT, an interesting editorial by Li and Szeto describes the success of the peritoneal dialysis (PD) programme in Hong Kong. The swift expansion of PD in Asia, and particularly in Hong Kong, is in sharp contrast with the tantalizing efforts of the PD community in Europe to prevent PD utilization rates from declining. Whereas in Hong Kong, the prevalence rates of PD are as high as 80%, in Europe, they are around a disappointing 15% [1]. The prevalence rates vary also substantially from country to country inside Europe, being 30% in the United Kingdom [3]. Even within different regions in each country, there are striking differences: in Spain, PD prevalence ranges between 31% in Cantabria and 11% in Catalonia, and in Italy it ranges between 16% in Liguria and 2% in Campania [4]. All these facts make it clear that the penetration rate of PD in Europe is most likely not only attributable to differences in patient mix [5,6]. In this short comment, we will use the successful PD programme in Hong Kong as the benchmark to explore which factors do have an influence, and, more importantly, how they can be changed to improve PD utilization in Europe. Would an increase in peritoneal dialysis utilisation in Europe offer advantages? A first and important point is of course related to patient survival. As shown in the Hong Kong experience, survival rates on PD can be excellent, with 2-year survival rates, unadjusted for age, of 83%. In Europe, the gender- and age-adjusted 2- and 3-year survival rates are 79% and 68%