80% of kidney patients call for home peritoneal dialysis to become national program: survey

Eight out of 10 patients receiving home peritoneal dialysis reported an improved quality of life compared to those receiving hemodialysis. The convenience of home peritoneal dialysis allowed patients to utilize an average of 20 additional hours per week for economic activities, leisure, or caregiving. Consequently, calls are growing to transition the home peritoneal dialysis pilot program into a full-scale initiative.

The Korean Society of Nephrology conducted an online survey from Sept. 3 to 13, targeting 98 institutions nationwide that provide peritoneal dialysis. This survey, aimed at “evaluating the effectiveness of the home-based peritoneal dialysis pilot program,” received responses from 452 patients, 112 physicians, and 99 nurses.

99% of patients would recommend home peritoneal dialysis to others

First, compared to hemodialysis, 76 percent of respondents reported that their quality of life had improved. Not a single respondent reported that their quality of life had worsened due to peritoneal dialysis.

The top advantage of home peritoneal dialysis, as cited by 52 percent, was convenience in daily life and time management. This was followed by the ability to concurrently engage in economic (or academic) activities (27 percent), reduced frequency of hospital visits (17 percent), and the ability to concurrently provide care/support for others (2 percent). Other responses included psychological stability from receiving treatment while resting in the comfortable environment of home, as well as fewer dietary restrictions.

Conversely, the most frequently cited difficulties with peritoneal dialysis were concerns about infection (46 percent), followed by handling emergency situations (26 percent), catheter management (10 percent), financial burden (10 percent), and other issues (8 percent).

When asked if starting home peritoneal dialysis affected their economic activities or studies, only 5 percent reported that it became difficult.

In contrast, 17 percent reported no impact at all, while 78 percent reported some impact but said it was manageable. Notably, choosing peritoneal dialysis freed up an additional 20 hours per week for these individuals. They reported using this time as follows: 45 percent for economic activities, 23 percent for personal hobbies (travel and outings), 16 percent for caregiving/support, and 14 percent for family time.

When peritoneal dialysis was not possible, 34 percent of respondents indicated that they would experience a maximum monthly disruption of approximately 100 hours to their economic activities or studies. Another 33 percent reported a maximum of about 200 hours, and 18 percent reported disruption exceeding 200 hours.

Regarding willingness to recommend peritoneal dialysis to other patients, 99 percent expressed intent to do so.

Notably, 95 percent of patients reported satisfaction with the Ministry of Health and Welfare's home-based peritoneal dialysis pilot program, which has been implemented since 2019. When asked about their greatest satisfaction, the most frequently cited factor was ease of communication with nurses (77 percent).

Medical workers point to urgent need for staffing, fee supplementation

Medical professionals also highly evaluated the effectiveness of the pilot program. The majority of physicians responded that the peritoneal dialysis pilot program “helped activate treatment” (89 percent) and believed that “after participating in the pilot program, the quality of life, satisfaction, and treatment adherence of peritoneal dialysis patients improved” (86 percent).

Nurses also answered that the pilot program “helped activate treatment” (76 percent). When asked if they “perceived an improvement in peritoneal dialysis patients' quality of life, satisfaction, and willingness to continue treatment after participating in the pilot program,” 78 percent responded that they “perceived an improvement.”

However, structural limitations were pointed out. It was noted that operating at a loss is inevitable under the current pilot program fee schedule.

When asked, “How financially viable is the current pilot program fee schedule for operating a peritoneal dialysis center?” 58 percent of respondents answered that it was a loss. They warned that under the current fee structure, “maintaining the number of peritoneal dialysis patients is difficult” (56 percent).

Accordingly, 76 percent of responding physicians suggested that a fee increase of approximately 400,000 won ($286) to 1.6 million won per month is necessary to increase the number of patients undergoing peritoneal dialysis.

Overwhelming demand for home peritoneal dialysis to become a full-scale program

Some 97 percent of patients, 92 percent of physicians, and 78 percent of nurses responded that “the pilot program should be converted into a full-scale program.”

A staggering 97 percent of patients expressed the opinion that “conversion to a full-scale program is necessary,” and 94 percent responded that “they would be willing to continue participating if it were converted.” When asked, “If the domestic peritoneal dialysis treatment environment deteriorates, what concerns you most?” the top worry was “having to switch to hemodialysis because peritoneal dialysis becomes difficult” (77 percent).

However, patients identified the following as essential improvements needed for the transition to a full-scale program: expanding communication with medical staff (58 percent) and strengthening remote management (43 percent).

Nurses responded that “it is necessary to transition the peritoneal dialysis pilot program into a full-scale program” (78 percent) and that “support for personnel and reimbursement rates is needed” (61 percent) to promote peritoneal dialysis. Specifically, they identified the following as essential improvements for the full-scale program: expanding the dedicated nursing staff (71 percent), and realistic education and counseling reimbursement rates (72 percent).

They reported a lack of nurse support systems in home peritoneal dialysis management (69 percent), with a shortage of dedicated personnel identified as the primary factor (87 percent).

Regarding physicians, 92 percent responded that the current pilot program needs to be transitioned into a full-scale national policy program. However, even if it transitions to a full-scale program, 37 percent stated they would not participate unless reimbursement rates and infrastructure improvements are implemented.

With the home peritoneal dialysis pilot program set to end this December, attention is focused on whether the Ministry of Health and Welfare can prepare personnel and reimbursement rate improvement measures alongside the transition to a full-scale program.