Overcoming barriers and building a strong peritoneal dialysis programme – Experience from three South Asian countries.

Klara Paudel¹, Ahad Qayyum², Abdul WM Wazil³, Sanjib K Sharma⁴, Kalpana Shrestha⁵, Stanley Fan⁶, Agnes Haris⁷, Fredric O Finkelstein⁸, Nishanthe Nanayakkara³

¹Department of Medicine, Charak Memorial Hospital, Pokhara, Nepal
²Department of Nephrology, Bahria Town Hospital, Lahore, Pakistan
³Department of Nephrology, Teaching Hospital, Kandy, Sri Lanka
⁴Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
⁵Department of Nephrology, Shahid Dharma Bhakta National Transplant Center, Kathmandu, Nepal
⁶Department of Renal Medicine and Transplantation, Barts Health NHS, London, UK
⁷Department of Nephrology, Peterfy Hospital, Budapest, Hungary
⁸Department of Medicine, Yale University, New Haven, CT, USA

Abstract

The development of peritoneal dialysis (PD) programmes in lower-resource countries is challenging. This article describes the learning points of establishing PD programmes in three countries in South Asia (Nepal, Sri Lanka and Pakistan). The key barriers identified were government support (financial), maintaining stable supply of PD fluids, lack of nephrologist and nurse expertise, nephrology community bias against PD, lack of nephrology trainee awareness and exposure to this modality. To overcome these barriers, a well-trained PD lead nephrologist (PD champion) is needed, who can advocate for this modality at government, professional and community levels. Ongoing educational programmes for doctors, nurses and patients are needed to sustain the PD programmes. Support from well-established PD centres and international organisations (International Society of Peritoneal Dialysis (ISPD), International Society of Nephrology (ISN), International Pediatric Nephrology Association (IPNA) are essential.

Keywords

Barrier, continuous peritoneal dialysis, developing country, service development, training

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