Who Cannot Receive Peritoneal Dialysis? Strategies to Unveil the Myths

Taiwan had the highest incidence of end-stage renal disease (ESRD) until recently, when this notorious record was finally revoked through the efforts of the Taiwanese government along with the Taiwan Society of Nephology and its member nephrologists, nursing staffs, researchers, and public health advocates. However, the prevalence of chronic dialysis remains the highest, creating a substantial burden to the healthcare system. Peritoneal dialysis (PD) is under-utilized compared with hemodialysis (HD) as a modality for renal replacement therapy in patients with ESRD, as in other countries; however, the reasons for this have not been previously investigated domestically. Here, we attempted to elaborate on the potential myths of low PD usage in Taiwan by using balance score card analysis, which includes aspects of patient outcome, finance, learning and growth, and infrastructure domains. The outcome for patients undergoing PD was previously inferior to that of patients undergoing HD; however, recent analysis demonstrates that PD outcomes have improved both in the USA and in Taiwan. Competent nephrologists should actively offer honest and up-to-date, rather than historical, information on PD outcomes to all patients with ESRD who need dialysis. We do and we learn, therefore we realize only few ESRD patients cannot receive PD as a renal replacement modality.