Peritoneal Dialysis International, Vol. 28, pp. 13–19 Printed in Canada. All rights reserved. 0896-8608/08 $3.00 + .00 Copyright © 2008 International Society for Peritoneal Dialysis 13 PD IN THE DEVELOPING WORLD CHRONIC PERITONEAL DIALYSIS IN SOUTH ASIA — CHALLENGES AND FUTURE Georgi Abraham, 1 Balaji Pratap, 1 Suresh Sankarasubbaiyan, 2 Priyanka Govindan, 1 K. Shivanand Nayak, 3 Rezvi Sheriff, 4 and S.A. Jaffar Naqvi 5 Sri Ramachandra University Hospital 1 ; Sundaram Medical Foundation, 2 Chennai; Global Hospital, 3 Hyderabad, India; Western Infirmary, 4 Colombo, Sri Lanka; and Pakistan Kidney Foundation, 5 Karachi, Pakistan Correspondence to: G. Abraham, Sri Ramachandra Medical College and Research Institute, Chennai, 600 116, India. abraham_georgi@yahoo.com Received 6 March 2007; accepted 30 November 2007. Chronic peritoneal dialysis (PD), especially continuous ambulatory PD (CAPD), is being increasingly utilized in South Asian countries (population of 1.4 billion). There are divergent geopolitical and socioeconomic factors that in- fluence the growth and expansion of CAPD in this region. The majority of the countries in South Asia are lacking in government healthcare system for reimbursing renal re- placement therapy. The largest utilization of chronic PD is in India, with nearly 6500 patients on this treatment by the end of 2006. A large majority of patients are doing 2 L ex- changes 3 times per day, using glucose-based dialysis solu- tion manufactured in India. Chronic PD is not being utilized in Myanmar, Bhutan, or Seychelles. Affirmative action by the manufacturing industry, medical professionals, govern- ment policy makers, and nongovernmental organizations for reducing the cost of chronic PD will enable the growth and utilization of this life-saving therapy. Perit Dial Int 2008; 28:13–19 www.PDIConnect.com KEY WORDS: Chronic peritoneal dialysis; South Asian countries; socioeconomic and geopolitical diversity. T he burden of end-stage renal disease (ESRD) in South Asian countries remains unknown due to poor access to health care, lack of an organized chronic disease man- agement program, and absence of disease registries. In addition, due to the socioeconomics of the region, there is a major shortfall in the financial resources and exper- tise required to care for patients with chronic kidney dis- ease (CKD). It is estimated that over 90% of the ESRD patients in South Asian countries cannot afford long- term renal replacement therapy (RRT) and die within weeks to months of diagnosis (1). In a recent population-based survey, diabetes was the cause of CKD in 41% of patients (2). A recent multicenter study found diabetic nephropathy as the etiology in 29% of the ESRD population (3). In South Asia the choice of mode of RRT is more influenced by nonmedical than medical factors and, as a consequence, chronic perito- neal dialysis (CPD) is still in its infancy in the region. The advantages of CPD pertinent to South Asia include autonomy, lifestyle, ability to do dialysis at home, and lack of need for vascular access (4–7). In addition, CPD reduces transmission of hepatitis B and C and HIV, and decreases the risk of delayed graft function in post-renal transplant recipients (6). GEOPOLITICAL AND SOCIOECONOMIC SITUATION The South Asian countries cumulatively have a popu- lation of nearly 1.4 billion and are comprised of India, Pakistan, Bangladesh, Myanmar, Sri Lanka, Nepal, Bhutan, Maldives, and the Republic of Seychelles (Fig- ure 1). The region is characterized by a diverse geo- political and socioeconomic environment (Table 1). These factors profoundly impact the healthcare system by guest on February 29, 2016 http://www.pdiconnect.com/ Downloaded from