Peritoneal Dialysis Use and Practice Patterns: An International Survey Study

Yeoungjee Cho, Aminu K. Bello, Adeera Levin, Meaghan Lunney, Mohamed A. Osman, Feng Ye, Gloria E. Ashuntantang, Ezequiel Bellorin-Font, Mohammed Benghanem Gharbi, Sara N. Davison, Mohammad Ghnaimat, Paul Harden, Htay Htay, Vivekanand Jha, Kamyar Kalantar-Zadeh, Peter G. Kerr, Scott Klarenbach, Csaba P. Kovesdy, Valerie Luyckx, Brendon NeuenDonal O'Donoghue, Shahrzad Ossareh, Jeffrey Perl, Harun Ur Rashid, Eric Rondeau, Emily J. See, Syed Saad, Laura Sola, Irma Tchokhonelidze, Vladimir Tesar, Kriang Tungsanga, Rumeyza Turan Kazancioglu, Angela Yee-Moon Wang, Chih Wei Yang, Alexander Zemchenkov, Ming hui Zhao, Kitty J. Jager, Fergus J. Caskey, Kailash K. Jindal, Ikechi G. Okpechi, Marcello Tonelli, David C. Harris, David W. Johnson

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Rationale & Objective: 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. Study Design: A cross-sectional survey. Setting & Participants: Stakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018. Outcomes: PD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures. Analytical Approach: Descriptive statistics. Results: 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. Limitations: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)315-325
Number of pages11
JournalAmerican Journal of Kidney Diseases
Issue number3
Publication statusPublished - Mar 2021


  • access to health care
  • affordability of health care
  • end-stage renal disease (ESRD)
  • Epidemiology
  • global survey
  • health care delivery
  • health care disparities
  • health policy
  • home dialysis
  • international differences
  • kidney failure
  • peritoneal dialysis (PD)
  • renal replacement therapy (RRT)
  • RRT modality

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