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



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.



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


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