What Is the Best Dialysis Therapy in Developed and Developing Countries? Peritoneal Dialysis and/or Hemodialysis: The Trend in Korea

In Korea, peritoneal dialysis (PD) penetration peaked around 2005 at 23%, after which it declined and has remained at 10.5%. Two factors possibly explain the decrease: more favorable physician incentives to perform hemodialysis (HD) and disincentives for private clinics to perform PD, even though they account for a large percentage of dialysis centers in Korea. Early referral to nephrologists has been shown to be associated with better survival and lower medical costs than late referral, highlighting a possible role for systemic intervention to encourage early referrals. This benefits patients by allowing adequate time for dialysis modality selection, relevant training, and preparation for dialysis. In cohorts enrolled from 2005 to 2008, HD showed better survival than PD in patients aged 55 and over. However, PD survival increased more sharply than HD survival over the past decade, a phenomenon particularly significant in diabetic patients and/or patients aged 65 and over. In a prospective study of a cohort enrolled since 2009, PD was associated with better survival than HD, particularly in the early period of dialysis. The survival advantage was shown to last about 3.5 years, with a particularly strong benefit in men or patients under 65. Given the average wait time of 5 years for deceased-donor kidney transplantation (KT) in Korea, PD might be preferably considered for young patients on the wait list. Two critical developments to monitor in PD patients are early death from pneumonia and high risk of acute myocardial infarction. Selection of a dialysis modality that delivers the greatest possible benefit to individual patients should consider age, diabetes status, and KT donor availability.