Peritoneal dialysis: Status report in South and South East Asia

Vinant Bhargava 1, Sanjiv Jasuja 2, Sydney Chi-Wai Tang 3, Anil K Bhalla 1, Gaurav Sagar 2, Vivekanand Jha 4, Raja Ramachandran 5, Manisha Sahay 6, Suceena Alexander 7, Tushar Vachharajani 8, Aida Lydia 9, Mamun Mostafi 10, Jayakrishnan K Pisharam 11, Chakko Jacob 12, Atma Gunawan 13, Goh Bak Leong 14, Khin Thida Thwin 15, Rajendra Kumar Agrawal 16, Kriengsak Vareesangthip 17, Roberto Tanchanco 18, Lina Choong 19, Chula Herath 20, Chih-Ching Lin 21, Syed Fazal Akhtar 22, Ali Alsahow 23, Devender Singh Rana 1, Mohan M Rajapurkar 24, Vijay Kher 25, Shalini Verma 26, Sampathkumar Krishnaswamy 27, Amit Gupta 28, Anupam Bahl 2, Ashwani Gupta 1, Umesh B Khanna 29, Santosh Varughese 7, Maurizio Gallieni 30

Affiliations

01 November 2021

-

doi: 10.1111/nep.13949

Abstract

Background: Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region.

Methods: The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HI & HMI) and low income and lower-middle income (LI & LMI) groups.

Results: Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%-7%). But there was a significant difference in per capita income (HI & HMI -US$ 28 129 vs. LI & LMI - US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization.

Conclusion: Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.

Keywords: APD; clinical nephrology; continuous renal replacement therapy; dialysis; end-stage kidney disease; peritoneal dialysis.

Similar articles

Peritoneal Dialysis Use and Practice Patterns: An International Survey Study.

Cho Y, Bello AK, Levin A, Lunney M, Osman MA, Ye F, Ashuntantang GE, Bellorin-Font E, Gharbi MB, Davison SN, Ghnaimat M, Harden P, Htay H, Jha V, Kalantar-Zadeh K, Kerr PG, Klarenbach S, Kovesdy CP, Luyckx V, Neuen B, O'Donoghue D, Ossareh S, Perl J, Rashid HU, Rondeau E, See EJ, Saad S, Sola L, Tchokhonelidze I, Tesar V, Tungsanga K, Kazancioglu RT, Yee-Moon Wang A, Yang CW, Zemchenkov A, Zhao MH, Jager KJ, Caskey FJ, Jindal KK, Okpechi IG, Tonelli M, Harris DC, Johnson DW.Am J Kidney Dis. 2021 Mar;77(3):315-325. doi: 10.1053/j.ajkd.2020.05.032. Epub 2020 Aug 12.PMID: 32800844

Peritoneal dialysis in Asia.

Cheng IK.Perit Dial Int. 1996;16 Suppl 1:S381-5.PMID: 8728228

Aetiology, practice patterns and burden of end-stage kidney disease in South Asia and South-East Asia: A questionnaire-based survey.

Sahay M, Jasuja S, Tang SCW, Alexander S, Jha V, Vachharajani T, Mostafi M, Pisharam JK, Jacob C, Gunawan A, Bak Leong G, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Cuong NT, Haian HP, Akhtar SF, Alsahow A, Rana DS, Rajapurkar MM, Kher V, Verma S, Ramachandran R, Bhargava V, Puri S, Sagar G, Bahl A, Mandal S, Gupta A, Gallieni M.Nephrology (Carlton). 2021 Feb;26(2):142-152. doi: 10.1111/nep.13825. Epub 2020 Dec 28.PMID: 33169890

Peritoneal Dialysis in Asia.

Kwong VW, Li PK.Kidney Dis (Basel). 2015 Dec;1(3):147-56. doi: 10.1159/000439193. Epub 2015 Sep 11.PMID: 27536675 Free PMC article. Review.

Changing Landscape for Peritoneal Dialysis: Optimizing Utilization.

Schreiber MJ Jr.Semin Dial. 2017 Mar;30(2):149-157. doi: 10.1111/sdi.12576. Epub 2017 Feb 1.PMID: 28144977 Review.

Cited by

Digital Healthy Diet Literacy and Fear of COVID-19 as Associated with Treatment Adherence and Its Subscales among Hemodialysis Patients: A Multi-Hospital Study.

Le LTH, Tran TT, Duong TV, Dang LT, Hoang TA, Nguyen DH, Pham MD, Do BN, Nguyen HC, Pham LV, Nguyen LTH, Nguyen HT, Trieu NT, Do TV, Trinh MV, Ha TH, Phan DT, Nguyen TTP, Nguyen KT, Yang SH.Nutrients. 2023 May 12;15(10):2292. doi: 10.3390/nu15102292.PMID: 37242175 Free PMC article.

Osteoporosis Risk in Hemodialysis Patients: The Roles of Gender, Comorbidities, Biochemical Parameters, Health and Diet Literacy.

Le LTH, Dang LT, Wang TJ, Do TG, Nguyen DH, Hoang TA, Pham MD, Do BN, Nguyen HC, Tran TT, Pham LV, Nguyen LTH, Nguyen HT, Trieu NT, Do TV, Trinh MV, Ha TH, Phan DT, Yang SH, Le NNM, Nguyen KT, Duong TV.Nutrients. 2022 Dec 2;14(23):5122. doi: 10.3390/nu14235122.PMID: 36501153 Free PMC article.

Economic evaluation of three dialysis methods in patients with end-stage renal disease in China.

Hong Z, Zhuang Y, Lu J, Ye J, Sun H, Gao L, Xiong Y.Int Urol Nephrol. 2023 May;55(5):1247-1254. doi: 10.1007/s11255-022-03402-2. Epub 2022 Nov 14.PMID: 36376531

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. Cho Y, Bello AK, Levin A, et al. Peritoneal dialysis use and practice patterns: an international survey study. Am J Kidney Dis. 2021;77:315-325. https://doi.org/10.1053/j.ajkd.2020.05.032
  2.  
    1. Wearne N, Kilonzo K, Effa E, et al. Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries. Int J Nephrol Renov Dis. 2017;10:1-9.
  3.  
    1. Reddy YNV, Abraham1 G, Mathew M, Ravichandran R, YNV1 R. An Indian model for cost-effective CAPD with minimal man power and economic resources. Nephrol Dial Transplant. 2011;26:1-3. https://doi.org/10.1093/ndt/gfr353
  4.  
    1. Jansen MA, Hart AA, Korevaar JC, et al. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int. 2002;62(3):1046-1053.
  5.  
    1. Jain AK, Blake P, Cordy P, Garg AX. Global trends in rates of peritoneal dialysis. J Am Soc Nephrol. 2012;23(3):533-544. https://doi.org/10.1681/ASN.2011060607
  6.  
    1. Himmelfarb J, Vanholder R, Mehrotra R, Tonelli M. The current and future landscape of dialysis. Nat Rev Nephrol. 2020;16:573-585.
  7.  
    1. Anand S, Bitton A, Gaziano T. The gap between estimated incidence of end-stage renal disease and use of therapy. PLoS One. 2013;8:e72860. https://doi.org/10.1371/journal.pone.0072860
  8.  
    1. Income and Health initiative: Brief one. Woolf SH, Aron L, Dubay L, Simon SM, Zimmerman E, Luk KX. How Are Income and Wealth Linked to Health and Longevity? Virginia Commonwealth University: Urban Institute.Centre on Society and Health. 2015 https://www.urban.org/site/default/files/publication/49116/2000178-How-a.... Accessed October 20, 2020.
  9.  
    1. Berkman L, Kawachi I, Glymour M. Social Epidemiology. 2nd. Oxford, England: Oxford University Press; 2014.
  10.  
    1. Garcia-Garcia G, Jha V. Chronic kidney disease in disadvantaged populations. Indian J Nephrol. 2015;25:65-69.
  11.  
    1. Parameswaran S, Geda SB, Rathi M, et al. Referral pattern of patients with end-stage renal disease at a public sector hospital and its impact on outcome. Natl Med J India. 2011;24:208-213.
  12.  
    1. Ashuntantang G, Osafo C, Olowu WA, et al. Out-comes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review. Lancet Glob Health. 2017;5(4):e408-e417. https://doi.org/10.1016/S2214-109X(17)30057-8
  13.  
    1. Leung CB, Cheung WL, Li PKT. Renal registry in Hong Kong-the first 20 years. Kidney Int Suppl. 2015;5:33-38.
  14.  
    1. Hyodo T, Hirawa N, Hayashi M, et al. Present status of renal replacement therapy at 2015 in Asian countries (Myanmar, Vietnam, Thailand, China, and Japan). Ren Replace Ther. 2017;3:11.
  15.  
    1. Tan J. Renal replacement therapy in Brunei Darussalam: comparing standards with international renal registries. Nephrol Ther. 2014;19:288-295.
  16.  
    1. Bujang MA, Adnan TH, Hashim NH, et al. Forecasting the incidence and prevalence of patients with end-stage renal disease in Malaysia up to the year 2040. Int J Nephrol. 2017;2017:2735296. https://doi.org/10.1155/2017/2735296
  17.  
    1. Singapore Renal Registry Annual Report 2018, 48/95
  18.  
    1. Lin Y-C, Hsu CY, Kao CC, et al. Incidence and prevalence of ESKD in Taiwan renal registry data system (TWRDS): 2005-2012. Acta Nephrologica. 2014;28:65-68.
  19.  
    1. Harsha Kumar HN. Rise in Haemodialysis cases- peritoneal dialysis could be a solution. Medical Dia-logues; 2020. https://speciality.medicaldialogues.in/rise-in-haemodialysis-cases-perit... Accessed May 17, 2020.
  20.  
    1. Hussain R, Tufail M, Tufail M, Naqvi S. Continuous ambulatory peritoneal dialysis (CAPD) as a model of renal replacement therapy (RRT) in children and adults - Pakistan experience. Indian J Perit Dial. 2006;11:10-13.
  21.  
    1. Sitprija V. Nephrology in South East Asia: fact and concept. Kidney Int. 2003;63:S128-S130. https://doi.org/10.1046/j.1523-1755.63.s83.27
  22.  
    1. Suceena Alexander, Sanjiv Jasuja, Maurizio Gallieni, et al. Impact of National Economy and policies on end-stage kidney Care in South Asia and Southeast Asia.International journal of nephrology, vol. 2021, 6665901, 11 pages, 2021. https://doi.org/10.1155/2021/6665901
  23.  
    1. Li PKT, Kai Ming C. Peritoneal dialysis-first policy made successful: perspectives and actions. Am J Kidney Dis. 2013;62(5):993-1005. https://doi.org/10.1053/j.ajkd.2013.03.038.
  24.  
    1. Bavanandan S, Ahmad G, Teo AH, Chen L, Liu FX. Budget impact analysis of peritoneal dialysis ver-sus conventional in-center hemodialysis in Malaysia. Value Health Reg Issues. 2016;9:8-14.
  25.  
    1. Liu FX, Quock TP, Burkart J, Noe LL, Inglese G. Economic evaluations of peritoneal dialysis and hemo-dialysis: 2004-2012. F1000Research. 2013;2(273):1-13. https://f1000research.com/articles/2-273.
  26.  
    1. Karopadi AN, Mason G, Rettore E, Ronco C. Cost of peritoneal dialysis and haemodialysis across the world. Nephrol Dial Transplant. 2013;28:2553-2569.
  27.  
    1. Kao TW, Chang YY, Chen PC, et al. Lifetime costs for peritoneal dialy-sis and hemodialysis in patients in Taiwan. Perit Dial Int. 2013;33:671-678. https://pubmed.ncbi.nlm.nih.gov/23636434/.
  28.  
    1. Yong K, Dogra G, Boudville N, Pinder M, Lim W. Acute kidney injury: controversies revisited. Int J Nephrol. 2011;2011:762634. https://doi.org/10.4061/2011/762634
  29.  
    1. Abraham G, Varughese S, Mathew M, Vijayan M. A review of acute and chronic peritoneal dialysis in developing countries. Clin Kidney J. 2015;8:310-317.
  30.  
    1. Li PKT, Szeto CC. Success of the peritoneal dialysis programme in Hong Kong. Nephrol Dial Transplant. 2008;23:1475-1478.
  31.  
    1. Jeloka TK, Upase S, Chitikeshi S. Monthly cost of three exchanges a day peritoneal dialysis is same as of thrice a week hemodialysis in self-paying Indian patients. Indian J Nephrol. 2012;22:39-41.
  32.  
    1. Health technology assessment development in Indonesia: progress and challenges. Health Technology Assessment Commission, Ministry of Heath Republic of Indonesia, 2016.
  33.  
    1. Widiana IGR. Dialysis treatment in Indonesia: focus on Bali. IOP Conf Ser: Mater Sci Eng. 2018;434:012334. https://iopscience.iop.org/article/10.1088/1757-899X/434/1/012334.
  34.  
    1. Manaf MRA, Surendra NK, Gafor AHA, Hooi LS, Bavanandan S. Dialysis provision and implications of health economics on peritoneal dialysis utilization: a review from a Malaysian perspective. Int J Nephrol. 2017;2017:5819629. https://doi.org/10.1155/2017/5819629

Page Navigation