scholarly journals Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

2015 ◽  
Vol 40 (4) ◽  
pp. 320-325 ◽  
Author(s):  
Agnes Shin-Man Choy ◽  
Philip Kam-Tao Li
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Financial Burden ◽  
Training Programme ◽  
Number Of Patients ◽  
Ultrafiltration Failure ◽  
Average Annual Cost ◽  
The Government ◽  
Stage Renal Disease ◽  
End Stage

In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy.

Development of the “Peritoneal Dialysis First” Model in Hong Kong

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 53-55 ◽  
Author(s):  
Alex Wai-Yin Yu ◽  
Ka-Foon Chau ◽  
Yiu-Wing Ho ◽  
Philip Kam-Tao Li
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Chronic Hemodialysis ◽  
Dialysis Unit ◽  
Number Of Patients ◽  
Maintenance Dialysis ◽  
The 1960S ◽  
Stage Renal Disease ◽  
End Stage

Maintenance dialysis is an expensive treatment modality for patients with end-stage renal-disease (ESRD). The number of patients on maintenance dialysis is rising rapidly and will reach 2.5 million globally by 2010. The predicted expenditure will be US$1 trillion. Since the 1960s, Hong Kong has faced financial restraints on the provision of dialysis. Continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis at home were found to be less expensive than in-centre chronic hemodialysis. The development of a “peritoneal dialysis first” (PD-First) policy has contributed significantly to a successful dialysis program in Hong Kong since 1960. Currently in Hong Kong, 80% of ESRD patients on maintenance dialysis are on PD, mainly CAPD; 20% are on hemodialysis. The success of the PD-First policy is a combination of accumulated experience of PD in each dialysis unit that has at least 200 CAPD patients under care and of impressive technique and patient survival rates for this modality. Concerted effort by government and charity organizations and commitment on the part of nephrologists and nursing staff to patient education are also important in making the PD program in Hong Kong a successful one.

Experience with Continuous Ambulatory Peritoneal Dialysis in Belgium

1980 ◽  
Vol 1 (5) ◽  
pp. 54-58 ◽  
Author(s):  
Norbert H. Lameire ◽  
Marc De Paepe ◽  
Raymond Vanholder ◽  
Johan Verbanck ◽  
Severin Ringoir
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Average Rate ◽  
Sodium Concentration ◽  
Risk Category ◽  
Diabetic Patients ◽  
Serum Triglycerides ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

This paper has reviewed experience in Belgium with 99 patients on CAPD. They represent 6-7% of all dialysis patients in this country. The principle reasons for selecting CAPD were old age, problems with vascular access and major cardiovas cular complications. Hemoglobin and hematrocrit values increased in all patients but preliminary measurements of red cell volume in some of them showed no change. Most patients showed moderate increases in serum triglycerides. In three non-diabetic patients with marked elevation in triglyceride levels, insulin, given intraperitoneally, prevented further increases. The frequency of peritonitis was still high; the average rate was one episode every 7.6 patient months. Other major complications included hypotension, which improved after the substitution of dialysate with a higher sodium concentration, severe respiratory disease and gangrene of the legs. After a mean follow-up of seven months, the death rate was 18% and the rate of technical success was 70%. The fact that most of our patients were in the high-risk category should be kept in mind when comparing these results with those obtained with other modes of treatment. At the end of 1978, a total of 1195 patients with end-stage renal disease (ESRD) were treated on either home or hospital dialysis in Belgium. There were 50 dialysis centers for a total population of 9.8 million. Of these 1195 patients, only seven were treated with either continuous ambulatory peritoneal dialysis (2-4) or intermittent peritoneal dialysis. Since then and until July 1, 1980 the number of patients treated with CAPD in Belgium has increased to 99 and this paper describes our experience with these patients.

Peritoneal Dialysis in Iran and the Middle East

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 217-221 ◽  
Author(s):  
Iraj Najafi
Keyword(s):  
Saudi Arabia ◽  
Peritoneal Dialysis ◽  
Middle East ◽  
End Stage Renal Disease ◽  
National Income ◽  
Number Of Patients ◽  
The Mean ◽  
Per Capita ◽  
Stage Renal Disease ◽  
End Stage

The countries of the Middle East have a cumulative population of 261.1 million and a mean gross national income per capita of US$9500. The total number of patients with end-stage renal disease (ESRD) in the Middle East is almost 100000, the mean prevalence being 430 per million population (pmp). The first implementation of intermittent peritoneal dialysis (PD) in the Middle East occurred in Turkey in 1968; continuous ambulatory PD started in Saudi Arabia, Turkey, and Kuwait in the 1980s; and automated PD, in Turkey in 1998. The total active PD patients in the region number approximately 8170. With 5750 patients, Turkey ranks first, followed by Iran and Saudi Arabia with 1150 and 771 patients respectively. Penetration of PD with respect to the ESRD population is 7.5%, and with respect to dialysis overall is 10.2%. The dialysis rate in the region, 312 pmp, is almost half the European number of 581 pmp, with a PD prevalence of 32 pmp (range: 0 – 81 pmp). The number of active PD patients has risen dramatically in the main countries since the end of the 1990s: Turkey, to 5750 from 1030; Saudi Arabia, to 771 from 132; and Iran to 1150 from 0.

scholarly journals Peritoneal Dialysis Utilization Globally and Opportunities in Lower Income Countries

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Fredric Finkelstein ◽  
Qamar Khan
Keyword(s):  
Peritoneal Dialysis ◽  
Low Income ◽  
Low Income Countries ◽  
Dramatic Improvement ◽  
Middle Income ◽  
Low Resource ◽  
Number Of Patients ◽  
The Government ◽  
Global Increase ◽  
End Stage

There has been an expansion of peritoneal dialysis (PD) utilization globally over the past several years. This has occurred for several reasons. First, there has been a global increase in the number of patients receiving end-stage kidney disease (ESKD) treatment in high income, middle income and low income countries. Second, recent studies have emphasized the reduced cost of PD compared to hemodialysis (HD) if PD supplies can be acquired at a reasonable cost.  Thirdly, it is now widely accepted that since PD is much simpler to do than HD (that is, it does not require large amounts of water, complex water treatment systems, electricity, and machinery), the use of PD in low resource countries has certain obvious advantages. Fourthly, it has become clear from experiences in Hong Kong and Thailand that have developed PD First programs (i.e. the government paying for ESKD care only if PD eligible patients start on PD rather than HD) and programs in Mexico (where there has been limited availability of HD centers) that the vast majority of patients with ESKD, even in low resource countries, are able to successfully be cared for with PD.  And, importantly, as programs expand in low resource countries and experience is gained, outcomes of  PD improve.  Lastly, the International Society of Peritoneal Dialysis (ISPD) has developed comprehensive guidelines for the care of PD patients that has resulted in a dramatic improvement in outcomes for PD patients over the last several years.

Direct and indirect costs of end-stage renal disease patients in the first and second years after initiation of nocturnal home haemodialysis, hospital haemodialysis and peritoneal dialysis

2019 ◽  
Vol 34 (9) ◽  
pp. 1565-1576 ◽  
Author(s):  
Carlos K H Wong ◽  
Julie Chen ◽  
Samuel K S Fung ◽  
Maggie M Y Mok ◽  
Yuk Lun Cheng ◽  
...  
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Indirect Costs ◽  
Direct And Indirect Costs ◽  
Second Year ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

AbstractPurposeTo estimate the direct and indirect costs of end-stage renal disease (ESRD) patients in the first and second years of initiating peritoneal dialysis (PD), hospital-based haemodialysis (HD) and nocturnal home HD.MethodsA cost analysis was performed to estimate the annual costs of PD, hospital-based HD and nocturnal home HD for ESRD patients from both the health service provider’s and societal perspectives. Empirical data on healthcare resource use, patients’ out-of-pocket costs, time spent on transportation and dialysis by ESRD patients and time spent by caregivers were analysed. All costs were expressed in Hong Kong year 2017 dollars.ResultsAnalysis was based on 402 ESRD patients on maintenance dialysis (PD: 189; hospital-based HD: 170; and nocturnal home HD: 43). From the perspective of the healthcare provider, hospital-based HD had the highest total annual direct medical costs in the initial year (mean ± SD) (hospital-based HD = $400 057 ± 62 822; PD = $118 467 ± 15 559; nocturnal home HD = $223 358 ± 18 055; P < 0.001) and second year (hospital-based HD = $360 924  ± 63 014; PD = $80 796 ± 15 820; nocturnal home HD = $87 028 ± 9059; P < 0.001). From the societal perspective, hospital-based HD had the highest total annual costs in the initial year (hospital-based HD = $452 151  ± 73 327; PD = $189 191 ± 61 735; nocturnal home HD = $242 038 ± 28 281; P < 0.001) and second year (hospital-based HD = $413 017 ± 73 501; PD = $151 520 ± 60 353; nocturnal home HD = $105 708 ± 23 853; P < 0.001).ConclusionsThis study quantified the economic burden of ESRD patients, and assessed the annual healthcare and societal costs in the initial and second years of PD, hospital-based HD and nocturnal home HD in Hong Kong. From both perspectives, PD is cost-saving relative to hospital-based HD and nocturnal home HD, except that nocturnal home HD has the lowest cost in the second year of treatment from the societal perspective. Results from this cost analysis facilitate economic evaluation in Hong Kong for health services and management targeted at ESRD patients.

scholarly journals Case Report: Recurring Peritonitis and Dialysis Failure in a Toddler on Peritoneal Dialysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Enas H. Mohammed ◽  
Sajimol Chandy ◽  
Abderrahman E. Kadhi ◽  
Ibrahim F. Shatat
Keyword(s):  
Peritoneal Dialysis ◽  
Past History ◽  
Posterior Urethral Valves ◽  
Refractory Anemia ◽  
Feeding Intolerance ◽  
Catheter Position ◽  
Plain Films ◽  
Ultrafiltration Failure ◽  
Stage Renal Disease ◽  
End Stage

We report a case of a 2-year-old-boy with end stage renal disease (ESRD) secondary to posterior urethral valves (PUV) on peritoneal dialysis (PD). Our patient developed multiple episodes of peritonitis, refractory anemia and feeding intolerance over a 12-month-period. He was treated with multiple courses of intraperitoneal antibiotics. Despite being on high-calorie formula, he was slowly thriving. The feeding intolerance was attributed to past history of prematurity, gastro-esophageal reflux disease and ESRD co-morbidities. He had anemia resistant to erythrocyte stimulating agents and iron supplementation. His family received re-training and mastered the PD techniques. They reported no breach of the aseptic techniques. His workup which included multiple AP abdominal XR-plain films were read as unremarkable and showed the gastrostomy tube (GT) and the PD catheter in good position. He completed his antibiotic courses as prescribed after each peritonitis episode, peritoneal fluid cultures repeated after each treatment completion showed no growth. During the last peritonitis episode, our patient developed ultrafiltration failure. A cross-table abdominal XR was obtained to evaluate the peritoneal catheter position and showed an intra-abdominal foreign body. During surgery, a needle was laparoscopically removed from the ileum and the PD catheter was replaced. Subsequently, our patient's feeding intolerance and resistant anemia resolved. Finally PD was successfully resumed.

Various Obstacles to Peritoneal Dialysis Development in Japan: Too Much Money? Too Much Fear?

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 56-58
Author(s):  
Yoshindo Kawaguchi
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Penetration Rate ◽  
Dialysis Patients ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
Almost All ◽  
End Stage

At 31 December 2005, the number of patients on maintenance dialysis in Japan was 257,765, with 9599 patients having started dialysis that year. Kidney transplant cases in Japan number about 1000 annually. Thus, almost all end-stage renal disease patients in Japan are likely to live on dialysis for the remainder of their lives. For various reasons, peritoneal dialysis has a lower penetration rate among Japanese dialysis patients, and work to educate patients and nephrologists about PD needs to be done.

scholarly journals Satisfaction and Improvements in Peritoneal Dialysis Outcomes Associated with Telehealth

2017 ◽  
Vol 26 (01) ◽  
pp. 214-225 ◽  
Author(s):  
Manya Magnus ◽  
Neal Sikka ◽  
Teena Cherian ◽  
Susie Lew
Keyword(s):  
Health Care ◽  
Peritoneal Dialysis ◽  
Positive Impact ◽  
Financial Burden ◽  
High School Degree ◽  
Important Means ◽  
Reducing Costs ◽  
Dialysis Outcomes ◽  
Stage Renal Disease ◽  
End Stage

SummaryBackground and Significance: End stage renal disease (ESRD) affects approximately 660,000 persons in the US each year, representing a significant financial burden to the health care system and affected individuals. Telehealth approaches to care offer an important means of reducing costs as well as increasing autonomy for patients. Understanding patient satisfaction with telehealth provides a key towards eventual scalability.Materials and Methods: Quarterly surveys were conducted to characterize satisfaction with remote biometric monitoring (RBM) for blood pressure, weight, glucose and peritoneal dialysis (PD)-specific educational online videos for ESRD patients using PD.Results: Of 300 participants, 67% participated in the surveys and provided baseline and at least one follow-up assessment. The majority were 45 to 64 years of age (50.5%), Black (64.5%), married or living with significant other (52.0%), and had more than a high school degree (73.0%). RBM was associated with perceived autonomy and confidence in health care activities and decreased negative perceptions of PD care and ESRD. The majority of participants (80.1%) indicated that they were satisfied or completely satisfied with the system. Participants found that the interface increased confidence, reduced frustration, and related perceptions were significantly and positively altered (p<0.05) for each of the separate telehealth components. Educational videos were well utilized with nearly half of the participants (42.5%) reporting that they watched at least one of the videos, and the majority reporting that the videos seen had an overall positive impact on health. Discussion and Conclusions: Supplementing PD with telehealth has the potential to have a positive impact on patient perceptions of PD care and consequently improve clinical outcomes.

scholarly journals Opinion: Peritoneal Dialysis In Pakistan: An Insider’s View. State of Affairs and Planning?

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Ahad Qayyum
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Dialysis Patients ◽  
Number Of Patients ◽  
Maintenance Dialysis ◽  
State Of Affairs ◽  
Stage Renal Disease ◽  
End Stage ◽  
Chronic Ambulatory Peritoneal Dialysis

Pakistan has an estimated population of 212 million while the incidence of end stage renal disease in Pakistan is 100 patients per million; hence approximately 22,000 patients require maintenance dialysis to sustain life in our country. Remarkably peritoneal dialysis (PD) as a form of maintenance renal replacement is utilized in less than one per cent of these patients.  In the absence of a formal dialysis registry, we place the total number of chronic ambulatory peritoneal dialysis patients (CAPD) in Pakistan at approximately 76 excluding holiday patients who are visiting from abroad (*This figure was estimated by enquiring the total number of patients each PD units care in Pakistan. This figure was corroborated with the sole distributor of CAPD fluids in Pakistan.).

Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients

2017 ◽  
Vol 46 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Marcela Avila ◽  
Carmen Mora ◽  
María del Carmen Prado ◽  
Miriam Zavala ◽  
Ramón Paniagua ◽  
...  
Keyword(s):  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Mineral Metabolism ◽  
Arterial Calcification ◽  
Rapid Progression ◽  
High Systolic Blood Pressure ◽  
Logistic Analysis ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

Background: Arterial calcification (AC) is frequent in patients with end stage renal disease and is also considered a risk factor for later morbidity and mortality. However, long-term factors associated with the process are not well known. We analyzed the trends over time of biomarkers related with development and progression of AC in incident patients on peritoneal dialysis (PD). Methods: We performed a prospective study with 186 patients on PD followed up for 1 year. We analyzed the progression of AC in the abdominal aorta and pelvic vessels by calcification score (CaSc), using16-cut computerized multidetector tomography at baseline and 1 year. Variables related with PD treatment, inflammation, and mineral metabolism were measured at baseline, 6, and 12 months of follow-up. Changes in biochemical variables were analyzed for their relationship with changes in AC. Results: Over 1 year, the number of patients with AC increased from 47 to 56%, and CaSc from 355 (interquartile range [IQR] 75-792) to 529 (IQR 185-1632). A total of 43.5% of patients remained free of calcification, 11.7% had new calcifications, and 44.8% had progression of calcification. Older age, diabetes, high systolic blood pressure, body mass index, cholesterol, and osteoprotegerin (OPG), as well as lower levels of albumin, serum creatinine, and osteocalcin, were associated with development of new, and rapid progression of, calcification. In multivariate logistic analysis, OPG remained the most significant (OR 1.27, 95% CI 1.11-1.47, p < 0.001). Conclusion: OPG was the strongest risk factor associated with new development and rapid progression of AC in incident PD patients.

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