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The Status of Peritoneal Dialysis in Europe – An Update
An illustration of the impact of privatisation of the RRT sector on the interesting paper written by the heads of a large chain of dialysis
utilisation of PD is Slovenia.
Between 1990 and 2003, the fraction of facilities in the US,
these observations are “associated but not
private HD patients increased from 13.1 to 21%: between 2000 and causative”. The authors argued that the decrease in the number of
2002, a decline in PD was observed, ranging between 12 and 3%. In home dialysis patients, including PD, is simply a reflection of the
2003, however, an increase in PD was noted of approximately 6%. diminished enthusiasm for prescribing home therapies by nephrologists
and the lack of an educational process for patients (and renal fellows)
An interesting analysis of the relation between reimbursement policies about the advantages of home therapies. The impact of the increase in
and utilisation of a given dialysis modality was recently published from dialysis facilities on the number of home patients has not been
The distribution of the payments for the expenditure of dialysis quantified, but the common result, as is widely acknowledged in
is such that the Ministry of Health covers over 60% of the costs of CAPD Canada, is a decrease in the number of home dialysis patients when
compared with 33% of those of HD. Despite CAPD being less expensive new inpatient facilities are made available in areas that previously had
overall, the major financing body (The Ministry of Finance) perceives none. It remains extremely important that patients and their families
CAPD as twice as expensive as HD so that, at least from the point of view experience as little disruption of their lifestyle as possible and that they
of the public health administrators, there is little financial incentive to continue to have choice. Thus, while the increased availability of
encourage PD. Despite this, PD as a treatment modality has increased inpatient HD facilities in more remote or rural areas may have affected
relatively from 0.64% in 1993 to 7.1% in 2003.
PD growth, it has also, in fact, allowed patients to have free choice
provided that they are well-informed about their treatment options.
A spectacular increase in PD utilisation has been observed in Romania, While this observation is probably true in the US, the growth in private
from 20pmp in 1995 to 952pmp in 2003. According to Romanian haemodialysis facilities may partly explain the arrest in PD growth, or
colleagues, this ‘success story’ is explained by poor infrastructure, long even its decline, in some of the former Eastern European countries.
distances to dialysis centres, adoption of the ‘integrated care’ approach
and an underdeveloped renal transplantation programme in Romania.
In conclusion, the utilisation of PD in Europe varies very widely. In some
countries, the prevalence of PD has risen during the last few years; in
It is interesting to compare the impact of privatisation of the RRT sector other non-European countries, a decline in its utilisation has been
on the utilisation of PD in Europe with the declining prevalence of PD observed. The reasons for this variability are numerous and this review
patients in the US that has occurred at the same time as the growth of has attempted to define a number of medical and non-medical factors
multicentre dialysis providers. However, according to a recent involved in this evolution. ■
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