CUHK Carol & Richard Yu PD Research Center, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China.
Kidney Dis (Basel). 2015 Dec;1(3):147-56. doi: 10.1159/000439193. Epub 2015 Sep 11.
There is a growing demand of dialysis in Asia for end-stage renal failure patients. Diabetes mellitus is the leading cause of end-stage renal failure in many countries in Asia.
The growth of peritoneal dialysis (PD) in Asia is significant and seeing a good trend. With the enhanced practices of PD, the quality of care in PD in Asia is also improved. Overall, PD and hemodialysis (HD) are comparable in clinical outcome. There is a global trend in the reduction of peritonitis rates and Asian countries also witness such improvement. The socio-economic benefits of PD for end-stage renal failure patients in both urban and rural areas in the developed and developing regions of Asia are an important consideration. This can help to reduce the financial burden of renal failure in addressing the growing demand of patients on dialysis. Initiatives should be considered to further drive down the cost of PD in Asia.
Growing demand for dialysis by an increasing number of end-stage renal failure patients requires the use of a cost-effective quality dialysis modality. PD is found to be comparable to HD in outcome and quality. In most countries in Asia, PD should be more cost-effective than HD. A 'PD-first' or a 'PD as first considered therapy' policy can be an overall strategy in many countries in Asia in managing renal failure patients, taking the examples of Hong Kong and Thailand.
(1) PD is cheaper than HD and provides a better quality of life worldwide, but its prevalence is significantly lower than that of HD in all countries, with the exception of Hong Kong. Allowing reimbursement of PD but not HD has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over the last years. In the Western world, however, HD is still promoted, and the proportion of patients treated with PD decreases. Japan remains an exception in Asia where PD penetration is very low. Lack of adequate education of practitioners and information of patients might as well be reasons for the low penetration of PD in both the East and West. (2) Patient survival of PD varies between and within countries but is globally similar to HD. (3) Peritonitis remains the main cause of morbidity in PD patients. South Asian countries face specific issues such as high tuberculosis and mycobacterial infections, which are rare in developed Asian and Western countries. The infection rate is affected by climatic and socio-economic factors and is higher in hot, humid and rural areas. (4) Nevertheless, the promotion of a PD-first policy might be beneficial particularly for remote populations in emerging countries where the end-stage renal disease rate is increasing dramatically.
亚洲终末期肾衰竭患者对透析的需求不断增长。在许多亚洲国家，糖尿病是导致终末期肾衰竭的主要原因。
亚洲腹膜透析（PD）的发展显著，呈良好趋势。随着 PD 实践的加强，亚洲 PD 的护理质量也得到了提高。总的来说，PD 和血液透析（HD）在临床结果方面相当。全球范围内，腹膜炎发生率呈下降趋势，亚洲国家也有所改善。PD 为城市和农村地区的终末期肾衰竭患者带来的社会效益经济效益，是一个重要的考虑因素。这有助于减轻肾衰竭患者的经济负担，满足不断增长的透析需求。应考虑采取措施进一步降低亚洲 PD 的成本。
不断增加的终末期肾衰竭患者对透析的需求需要使用一种具有成本效益的优质透析方式。PD 在结果和质量方面与 HD 相当。在亚洲大多数国家，PD 比 HD 更具成本效益。在亚洲许多国家，采用“PD 优先”或“PD 作为首选治疗方案”的策略，可以作为管理肾衰竭患者的总体策略，香港和泰国就是很好的例子。
（1）PD 比 HD 更便宜，并且在全球范围内提供更高的生活质量，但除了香港，PD 在所有国家的普及程度都明显低于 HD。在过去几年中，许多亚洲国家（如香港、越南、台湾、泰国以及新西兰和澳大利亚）允许报销 PD 但不报销 HD，从而使 PD 的使用量超过了 HD。然而，在西方世界，HD 仍在推广，接受 PD 治疗的患者比例正在下降。日本在亚洲是一个例外，其 PD 普及率非常低。从业人员教育不足和患者信息不足也可能是 PD 在东西方普及率低的原因。（2）PD 患者的生存率在国家之间和国家内部有所不同，但与 HD 全球相似。（3）腹膜炎仍然是 PD 患者发病的主要原因。南亚国家面临着一些特殊问题，如结核病和分枝杆菌感染，而这些问题在发达的亚洲和西方国家很少见。感染率受气候和社会经济因素的影响，在炎热、潮湿和农村地区更高。（4）然而，推行 PD 优先政策可能对新兴国家偏远地区的人口特别有益，这些地区的终末期肾病发病率正在急剧上升。
