Automated peritoneal dialysis in Asia

The socioeconomic statuses of Asian countries are diverse, and government reimbursement policies for renal replacement programs vary greatly from one country to another. Both factors affect not only the availability of treatment, but also the choice of dialysis modality. A close correlation is demonstrated between the dialysis treatment rate for end-stage renal disease (ESRD) and the gross domestic product (GDP) per capita income. A biphasic relationship with the GDP per capita income and the peritoneal dialysis (PD) utilization rate is observed, in that the countries with the highest and lowest treatment rates tend to have lower PD utilization rates, whereas countries with modest treatment rates tend to have higher PD utilization rates. In contrast, countries with high continuous ambulatory peritoneal dialysis (CAPD) utilization rates have the lowest automated peritoneal dialysis (APD) utilization rates. The low APD utilization rates are due to fact that, in most instances, patients themselves must purchase the APD machine, and the machines are relatively more expensive in Asian Pacific countries. Continuous cycling peritoneal dialysis (CCPD) is most frequently practiced. Generally, convenience for employment is the main indication for the utilization of APD. Other important indications are the convenience of treatment in young or elderly uremic patients. Contrary to the practice in CAPD treatment, detailed documentation of dialysis adequacy and nutritional status is not routinely done in patients undergoing APD treatment in most Asian Pacific countries. In conclusion, APD is an underdeveloped treatment modality in the renal replacement programs of Asian Pacific countries. The low utilization of APD is clearly influenced by non medical factors including government reimbursement policy and the cost of PD machines.