Global Trends in Rates of Peritoneal Dialysis

Abstract

Although there is a perception that the use of peritoneal dialysis is declining worldwide, compilations of global data are unavailable to test this hypothesis. We assessed longitudinal trends in the use of peritoneal dialysis from 1997 to 2008 in 130 countries. The preferred data sources were renal registries, followed by nephrology societies, health ministries, academic centers, national experts, and industry affiliates. In 2008, there were approximately 196,000 peritoneal dialysis patients worldwide, representing 11% of the dialysis population. In total, 59% were treated in developing countries and 41% in developed countries. Over 12 years, the number of peritoneal dialysis patients increased in developing countries by 24.9 patients per million population and in developed countries by 21.8 per million population. The proportion of all dialysis patients treated with peritoneal dialysis did not change in developing countries but significantly declined in developed countries by 5.3%. The use of automated peritoneal dialysis increased by 14.5% in developing countries and by 30.3% in developed countries. In summary, the number of patients treated with peritoneal dialysis rose worldwide from 1997 to 2008, with a 2.5-fold increase in the prevalence of peritoneal dialysis patients in developing countries. The proportion of all dialysis patients treated with this modality continues to decline in developed countries. Chronic dialysis is a life-sustaining treatment for patients with ESRD. Access to dialysis remains limited in several regions of the world due to a lack of financial and clinical resources. [1][2][3][4][5][6][7][8][9] As countries look to develop dialysis programs to manage the growing burden of ESRD, it is important to place patterns of peritoneal dialysis (PD) use in the global context. This information is particularly helpful to individuals in member nations responsible for health care delivery to evaluate their PD programs through comparisons with countries of similar socioeconomic structure.A comprehensive global assessment of PD use to date has been lacking. One study suggested that 11% of chronic dialysis patients around the world are treated with PD. 10 Several renal registries report PD use at a national and regional level, 11-14 but not on a global scale. There is a perception that PD use is declining worldwide. However, studies that showed declining PD use in the developed world are limited by the number of countries considered and the length of time examined. 3,[15][16][17] No study has examined the global use of different PD modalities over a significant period of time, including continuous ambulatory PD (CAPD) and automated PD (APD). For these reasons, we assessed PD use worldwide by compiling data from multiple sources over a 12-year period. We examined the trends in PD use across developing and developed nations, focusing on crude numbers, prevalence per million population, and the proportion of dialysis patients who received PD. We hypothesized an increasing PD prevalence in the dev...

Interstitial Fibrosis Restricts Osmotic Water Transport in Encapsulating Peritoneal Sclerosis

“…1,2 Functional alterations of the peritoneal membrane constitute an obstacle to long-term PD, because they are associated with technical failure and increased morbidity and mortality. [3][4][5] Prolonged exposure of the peritoneal membrane to nonphysiologic dialysis solutions leads to vascular proliferation, vasculopathy, and peritoneal fibrosis, with ensuing loss of ultrafiltration (UF) capacity resulting from enlarged vascular surface area, faster peritoneal solute transport rate, and early dissipation of the osmotic gradient.…”

Economic Impact of a Peritoneal Dialysis Continuous Quality Improvement Program in Colombia

“…In 2008, there were approximately 196,000 PD patients worldwide, or about 11% of the dialysis population. Among these, 59% were in developing countries, and the proportion of dialysis patients treated with PD in developing countries increased 2.5-fold between 1997 and 2008 (5). In Colombia, for example, 31.3% of patients on dialysis were reported as being treated with PD in 2012, and over 50% of new starts received PD (6,7).…”

Outcomes of Peritoneal Dialysis Patients and Switching to Hemodialysis: A Competing Risks Analysis

“…P eritoneal dialysis (PD) as a mode of renal replacement therapy has witnessed divergent trends in the last decade. While the outcomes continued to improve and were comparable to hemodialysis (HD) (1), the proportion of end-stage renal disease patients treated with this modality in developed countries declined (2). During this time, many investigative efforts of the PD community have been focused on studying the impact of new, more biocompatible solutions which became available around the start of millennium (3)(4)(5).…”