title: Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong.
abstract: In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy.
authors.affiliation: 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.
authors.forename: Agnes Shin-Man
authors.initials: AS
authors.lastname: Choy
authors.forename: Philip Kam-Tao
authors.initials: PK
authors.lastname: Li
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006291:Health Policy; D006723:Hong Kong; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D016030:Kidney Transplantation; D009026:Mortality; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome