Peritoneal Dialysis Use and Practice Patterns: An International Survey Study

ABSTRACT 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, policymakers, and patient representatives in 182 countries convened by the International Society of Nephrology (ISN) 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 160 (88%) countries; 313 participants (nephrologist n=257 [82%], non-nephrologist physician n=22 [7%], other health professional n=6 [2%], administrator/policy maker/civil servant n=17 [5%], other n=11 [4%]); from 156 (86%) countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 countries (19%), particularly in Africa (20/41) and other low-income (15/22) countries. 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 1–25% of treatment costs and higher (>75%) co-payments were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges/day or equivalent on 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 policymakers; 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 intra-regional 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.