Peritoneal Dialysis Patient Selection

Abstract

Peritoneal dialysis (PD) is highly underutilized worldwide with wide regional variation. In the United States, only 9% of end-stage kidney disease (ESKD) patients are on PD compared to rates as high as 79% in other countries. This exceptionally low rate is a worrying statistic for a developed country such as the United States and requires immediate attention. A recent NKF-KDOQI conference identified clinical, operational, societal, and policy-related factors that prevent access to PD as a modality of choice. When educated about their options, most patients would choose home dialysis as their preferred modality. Clinical studies and research from around the world have consistently shown that as a home-based dialysis therapy, PD is associated with improved patient survival, better preservation of residual kidney function, lower risk of infection, and increased patient satisfaction all while reducing financial stress to governments. According to Devoe et al. (2016), there is a strong association between patient-targeted dialysis modality education and selecting and receiving PD (Devoe DJ, et al. Patient education and peritoneal dialysis modality selection: A systematic review and meta-analysis. Am J Kidney Dis. 2016;68:422–33). Despite significant and widely accepted benefits of home dialysis, its utilization rate has remained unacceptably low in the United States (<2% for home hemodialysis (HHD) and < 10% for PD), rates far below that of other industrialized nations (Chan CT, et al. Exploring barriers and potential solutions in home dialysis: an NKF-KDOQI conference outcomes report. Am J Kidney Dis. 2018;73(3):363–71).