Changes in the worldwide epidemiology of peritoneal dialysis

Key Points Peritoneal dialysis is a high quality and cost-effective dialysis modality In the past decade the greatest increases in peritoneal dialysis utilization have occurred in China, Thailand and the USA; peritoneal dialysis utilization has decreased in parts of Europe and in Oceania Asia has experienced the largest absolute growth in patients on dialysis, and is characterized by the largest regional variation in peritoneal dialysis utilization Reimbursement schemes and government policy are important determinants of peritoneal dialysis epidemiology Peritoneal dialysis first policies (Hong Kong and Thailand), the peritoneal dialysis favoured policy (China) and the home dialysis first model (Australia and New Zealand) have resulted in increased utilization of peritoneal dialysis Major challenges to increased utilization of peritoneal dialysis — particularly in developing countries — include prohibitive costs, lack of trained medical personnel, disparities in health-care provision and a lack of infrastructure