RATIONALE & OBJECTIVE: Approximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe. STUDY DESIGN: A cross-sectional survey. SETTING & PARTICIPANTS: Stakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018. OUTCOMES: PD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures. ANALYTICAL APPROACH: Descriptive statistics. RESULTS: Responses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes. LIMITATIONS: Low responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data. CONCLUSIONS: Large inter- and intraregional disparities exist in PD availability, accessibility, affordability, delivery, and reporting of quality outcome measures around the world, with the greatest gaps observed in Africa and South Asia.

Centre for Kidney Disease Research University of Queensland Brisbane Australia; Translational Research Institute Brisbane Australia; Metro South and Ipswich Nephrology and Transplant Services Princess Alexandra Hospital Brisbane Australia

Centre for Transplantation and Renal Research Westmead Institute for Medical Research University of Sydney Sydney New South Wales Australia

Department of Community Health Sciences University of Calgary Calgary Alberta Canada

Department of Intensive Care Austin Health Melbourne Australia; School of Medicine University of Melbourne Melbourne Australia

Department of Internal Disease and Nephrology North Western State Medical University named after 1 I Mechnikov Saint Petersburg Russia; Department of Nephrology and Dialysis Pavlov 1st Saint Petersburg State Medical University Saint Petersburg Russia

Department of Medicine Faculty of Medicine King Chulalong Memorial Hospital Chulalongkorn University Bangkok Thailand; Bhumirajanagarindra Kidney Institute Bangkok Thailand

Department of Medicine The University of Hong Kong Queen Mary Hospital Hong Kong

Department of Nephrology General University Hospital Charles University Prague Czech Republic

Department of Nephrology Kidney Foundation Hospital and Research Institute Dhaka Bangladesh

Department of Nephrology Monash Medical Centre Monash Health Clayton Victoria Australia; Department of Medicine Monash University Clayton Victoria Australia

Department of Renal Medicine Singapore General Hospital Singapore

Dialysis Unit CASMU IAMPP Montevideo Uruguay

Division of Nephology and Hypertension Department of Medicine Saint Louis University Saint Louis MO

Division of Nephrology and Hypertension University of California Irvine Medical Center Orange CA

Division of Nephrology and Hypertension University of Cape Town Cape Town South Africa

Division of Nephrology and Immunology Department of Medicine University of Alberta Edmonton Alberta Canada

Division of Nephrology Bezmialem Vakif University Istanbul Turkey

Division of Nephrology Department of Medicine Hasheminejad Kidney Center Iran University of Medical Sciences Tehran Iran

Division of Nephrology Department of Medicine University of British Columbia Vancouver British Columbia Canada

Division of Nephrology St Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute St Michael's Hospital Toronto Ontario Canada; Division of Nephrology Department of Medicine University of Toronto Toronto Ontario Canada

ERA EDTA Registry Department of Medical Informatics Academic Medical Center Amsterdam Public Health Research Institute University of Amsterdam Amsterdam the Netherlands

Faculty of Medicine and Biomedical Sciences Yaounde General Hospital University of Yaounde 1 Yaounde Cameroon

George Institute for Global Health UNSW New Delhi India

George Institute for Global Health UNSW New Delhi India; George Institute for Global Health University of Oxford Oxford United Kingdom; Manipal Academy of Higher Education Manipal India

Institute of Biomedical Ethics and the History of Medicine University of Zurich Zurich Switzerland; Renal Division Brigham and Women's Hospital Harvard Medical School Boston MA

Intensive Care Nephrology and Transplantation Department Hopital Tenon Assistance Publique Hopitaux de Paris Paris France; Sorbonne Université Paris France

Kidney and Hypertension Research Unit University of Cape Town Cape Town South Africa; Department of Medicine University of Calgary Calgary Alberta Canada

Kidney Research Center Department of Nephrology Chang Gung Memorial Hospital Chang Gung University College of Medicine Taoyuan Taiwan

Nephrology Development Clinical Center Tbilisi State Medical University Tbilisi Georgia

Nephrology Division Department of Internal Medicine The Specialty Hospital Amman Jordan

Oxford Kidney Unit Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom

Pan American Health Organization World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease University of Calgary Calgary Alberta Canada; University of Leicester Leicester United Kingdom

Population Health Sciences University of Bristol Bristol United Kingdom; Renal Unit Southmead Hospital North Bristol NHS Trust Bristol United Kingdom

Renal Division Department of Medicine Peking University 1st Hospital Beijing China; Key Lab of Renal Disease Ministry of Health of China Beijing China; Key Lab of Chronic Kidney Disease Prevention and Treatment Ministry of Education of China Beijing China; Peking Tsinghua Center for Life Sciences Beijing China

Salford Royal NHS Foundation Trust Salford United Kingdom; University of Manchester Manchester United Kingdom

University of Tennessee Health Science Center Memphis TN

Urinary Tract Diseases Department Faculty of Medicine and Pharmacy of Casablanca University Hassan 2 of Casablanca Casablanca Morocco

Am J Kidney Dis. 2021 Mar;77(3):309-311. doi: 10.1053/j.ajkd.2020.10.005. PubMed

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