What Is the Best Dialysis Therapy for South Asia: HD or PD?

Background: South Asian countries have a population of 1.7 billion and are classified as low-middle to poor income nations. Their health care systems cannot presently meet the growing need for renal replacement therapy (RRT), provided as haemodialysis or peritoneal dialysis (PD). Most patients cannot afford the treatment and quickly default. Furthermore, most of the population is located in rural areas, where there are few treatment centres; therefore, there is a huge gap between those treated and those in need. Summary: PD can bridge this gap and can serve as a first line of therapy if it becomes more affordable. Government reimbursement schemes, the Once-in-a-Lifetime Payment Scheme, and PD insurance all provide strong impetus to dialysis programmes. Local manufacturing of PD fluid has also reduced the cost of therapy to some extent. PD may be preferable for patients with cardiovascular morbidity and it also obviates the risk of transmission of blood-borne diseases such as HIV, hepatitis B, and hepatitis C. In our own centre, automated PD is being used as initial RRT for acute kidney injury with good results. In prospective transplant recipients, PD has been found to decrease the risk of posttransplant graft dysfunction. Key Messages: Remote PD and home visits by PD clinical coordinators have brought faraway patients and their nephrologists closer with the use of technology. For these reasons, the current pressing need is to bring PD to the forefront of RRT in resource-poor countries in South Asia to enable universal treatment of patients with renal disease.