Foreign Perspective on Achieving a Successful Peritoneal Dialysis-First Program

The global burden of CKD is increasing and it is estimated up to one in ten of the adult population has CKD, totaling around 850 million people worldwide (1). The major causes of CKD leading to ESKD are diabetes mellitus (DM), glomerular diseases, and hypertension (2). The epidemic of DM contributes to the major burden of CKD because, in 2010, 285 million (6%) of the adult population worldwide had DM and this is projected to increase to 8% in 2030 (2).When patients with CKD reach ESKD, they will require RRT. Currently, the most common modalities are hemodialysis (HD) and peritoneal dialysis (PD). Continuous ambulatory PD (CAPD) started in 1976 and has gradually gained worldwide recognition as an established form of high-quality, cost-effective RRT for patients with kidney failure (3). Despite this, the global utilization of PD has remained <15%. Currently, PD can be divided into CAPD and automated PD (APD). Both CAPD and APD are home therapies for patients on dialysis, with the ratio of APD to CAPD varying in different countries. In 2019, President Trump signed the Executive Order on Advancing American Kidney Health (AAKH) (4). One of the three goals of the initiative is ensuring that 80% of new patients with kidney failure receive either dialysis at home or a kidney transplant by 2025. Lessons learned from other countries where utilization of PD is higher is therefore relevant to the United States nephrology community.A “PD-First Policy” was first coined and introduced in Hong Kong (HK) in 1985 (5). This program was started by the Central Renal Committee of the Medical and Health Department and later by the Hospital Authority of HK Government in light of rising demand from the escalating number of patients with kidney failure requiring dialysis (6).The policy stated that all …