Peritoneal dialysis first policy in Hong Kong for 35 years: Global impact

Abstract

Peritoneal dialysis (PD) first policy has been established in Hong Kong since 1985. After 35 years of practice, the PD first policy in Hong Kong has influenced many countries around the world including governments, health ministries, nephrologists and renal nurses on the overall health policy structure and clinical practice in treating kidney failure patients using PD as an important dialysis modality. In 2021, the International Association of Chinese Nephrologists and the Hong Kong Society of Nephrology jointly held a symposium celebrating the 35 years of PD first policy in Hong Kong. In that symposium, experts and opinion leaders from around the world have shared their perspectives on how the PD first policy has grown and how it has affected PD and home dialysis practice globally. The advantages of PD during COVID-19 pandemic were highlighted and the use of telemedicine as an important adjunct was discussed in treating kidney failure patients to improve the overall quality of care. Barriers to PD and the need for sustainability of PD first policy were also emphasized. Overall, the knowledge awareness of PD as a home dialysis for patients, families, care providers and learners is a prerequisite for the success of PD first. A critical mass of PD regional hubs is needed for training and mentorship. Importantly, the alignment of policy and clinical goals are enablers of PD first program.

Keywords: Hong Kong; PD first policy; global impact; peritoneal dialysis.

FIGURE 1

Number of end stage kidney disease (ESKD) patients on kidney replacement therapy (KRT) in Hospital Authority in Hong Kong as shown by the prevalent counts of the three modes of KRT‐Transplant, HD and PD as of 31 Dec each year. From 1996 to 2021, dialysis patients in HA increased 3.06 times from 2261 to 6909, with PD patients increasing from 1865 to 5086, a 2.73‐fold increase. Source: Data are from Hong Kong Renal Registry, Central Renal Committee, Hospital Authority

FIGURE 2

PD services in all 16 Hospitals of Hospital Authority from 1995 till 2021, as of 31/12 each year. TMH, Tuen Mun Hospital; PWH, Prince of Wales Hospital; UCH, United Christian Hospital; PMH, Princess Margaret Hospital; PYNEH, Pamela Youde Nethersole Eastern Hospital; QEH, Queen Elizabeth Hospital; KWH, Kwong Wah Hospital; AHNH, Alice Ho Miu Ling Nethersole Hospital; QMH, Queen Mary Hospital; CMC, Caritas Medical Centre; POH, Pok Oi Hospital; NDH, North District Hospital; TWH, Tung Wah Hospital; TKOH, Tseung Kwan O Hsopital; YCH, Yan Chai Hospital; PMH‐Paed/HKCH, Princess Margaret Hospital‐Paediatric/Hong Kong Children Hospital. Source: Data are from Hong Kong Renal Registry, Central Renal Committee, Hospital Authority

FIGURE 3

Learnings from Hong Kong's PD‐first Policy