The status of, and obstacles to, continuous ambulatory peritoneal dialysis in Thailand.

The prevalence of dialysis in Thailand is 282 per million population, and utilization of peritoneal dialysis (PD) is only 4.6% of the utilization of hemodialysis (HD). The causes of low PD utilization include a relatively higher cost of PD care, especially from the patient's perspective; less incentive for PD care on the part of health care providers and hospitals; fewer continuing medical and nursing education programs in PD; unavailability of certified PD nurses; lack of confidence in the quality of PD care; fewer offers of PD as a renal replacement therapy option during pre-dialysis counseling; fear of peritonitis on the part of the patient, and also fear of burdening family members; a less stringent government policy regarding the "PD first" strategy. To increase PD utilization. mandatory strategies are lower PD cost, make all PD equipment reimbursable, launch a stringent "PD first" policy, provide incentives to health care providers and hospitals, and improve the quality of PD care.