In the article entitled “Peritoneal Dialysis in China: Meeting the Challenge of Chronic Kidney Failure,” Yu et al describe the problematic aspects of ESRD coverage in China. It has been recognized that PD offers some advantages over hemodialysis (HD), and is non-inferior with respect to mortality. However, PD requires a multidisciplinary program and a team management that is difficult to achieve in many rural areas. It is well known that PD outcomes largely depend on the PD program, catheter-access center, and patient education. If PD is done in large and well-developed referral centers, it is efficient and has a higher impact on quality of life, lower cost, and allows patients adequate work and family adaptation. Unfortunately, most of the PD patients in rural China, Latin America, and other developing countries do not have access to these multidisciplinary facilities. In Mexico, for instance, 65% of the population receives PD for renal replacement therapy, but 50% of all ESRD patients do not have access to treatment. Furthermore, of those patients undergoing PD, death is the major cause of dropout, occurring in the majority of the patients within the first 3 months of treatment. These negative outcomes reflect the limited resources for sufficient training, education, and quality of care in this population. Health systems in these countries are barriers to health care, and ESRD represents a disease where equitable patient care is nonexistent. Facing this challenge in the next decades does not seem an easy task. Programs aiming to prevent CKD and its risk factors appear to be one of the most promising strategies to decrease the burden of the disease.
Dr. Magdalena Madero
AJKD Blog Contributor