Abstract image representing the balance of cost and care in kidney disease treatment.

Hong Kong's Dialysis-First Policy: Balancing Care and Costs

Jordan Keane in Health & Wellness June 2025 • 3 min read.

"Explore how Hong Kong's unique approach to kidney disease treatment prioritizes peritoneal dialysis, ensuring sustainable and effective patient care."

In Hong Kong, the approach to treating end-stage renal disease (ESRD) stands out due to its emphasis on peritoneal dialysis (PD). This method, often favored for its cost-effectiveness and patient-centered benefits, has been a cornerstone of the region's healthcare strategy for decades.

With the incidence of ESRD posing a significant financial challenge, the Hong Kong government implemented a PD-first policy. This initiative not only addresses the economic burden but also ensures that patients receive optimal care, tailored to their needs and circumstances.

This article delves into the intricacies of Hong Kong's PD-first policy, examining its implementation, successes, challenges, and future directions. By understanding the strategies and outcomes, healthcare professionals and policymakers can gain insights into creating sustainable and effective renal care systems worldwide.

Why Prioritize Peritoneal Dialysis? Unpacking the Benefits

Abstract image representing the balance of cost and care in kidney disease treatment.

Hong Kong's PD-first policy is rooted in several key advantages that PD offers over hemodialysis (HD). A major consideration is cost-effectiveness. Studies show that the annual cost of HD per patient is significantly higher than that of PD. By prioritizing PD, Hong Kong manages to allocate healthcare resources more efficiently, ensuring more patients receive the treatment they need.

Beyond economics, PD offers notable clinical benefits. Research indicates that patients receiving PD may experience a survival advantage, particularly in the initial period of dialysis therapy. This can be attributed to:

Better preservation of residual renal function (RRF)
Greater haemodynamic stability
Reduced risk of ischemic kidney insult
Lower exposure to inflammatory mediators compared to HD

The preservation of RRF is particularly crucial as it significantly contributes to overall patient health and survival. Accumulating evidence supports the idea that maintaining even a small degree of kidney function can lead to better outcomes for dialysis patients. Studies have also found that PD is associated with a slower decline in RRF compared to HD, making it a preferred option for long-term kidney health management.

Looking Ahead: Sustaining and Enhancing Hong Kong's PD-First Policy

Hong Kong's PD-first policy demonstrates a commitment to innovative and patient-centered healthcare. By addressing challenges, optimizing resources, and embracing new strategies, Hong Kong can continue to lead the way in sustainable and effective renal care.

About this Article -

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Everything You Need To Know

What makes Hong Kong's approach to treating end-stage renal disease (ESRD) unique?

Hong Kong's approach to treating end-stage renal disease (ESRD) is unique because it prioritizes peritoneal dialysis (PD) as the first-line treatment. This PD-first policy is a cornerstone of their healthcare strategy, emphasizing cost-effectiveness and patient-centered benefits. By favoring PD, Hong Kong aims to manage the economic burden associated with ESRD while ensuring patients receive optimal care tailored to their needs and circumstances. This strategy differs from other regions where hemodialysis (HD) might be more commonly used as an initial treatment.

What are the key advantages of peritoneal dialysis (PD) over hemodialysis (HD) that support Hong Kong's PD-first policy?

Hong Kong's PD-first policy is supported by several key advantages of peritoneal dialysis (PD) over hemodialysis (HD). Primarily, PD is more cost-effective, allowing for efficient allocation of healthcare resources to treat a larger number of patients. Clinically, PD offers benefits such as better preservation of residual renal function (RRF), greater hemodynamic stability, a reduced risk of ischemic kidney insult, and lower exposure to inflammatory mediators compared to HD. The preservation of RRF is particularly important as it significantly contributes to overall patient health and survival.

How does Hong Kong's PD-first policy address the financial challenges associated with treating end-stage renal disease (ESRD)?

Hong Kong's PD-first policy directly addresses the financial challenges of treating end-stage renal disease (ESRD) by leveraging the cost-effectiveness of peritoneal dialysis (PD). Studies have demonstrated that the annual cost per patient for hemodialysis (HD) is significantly higher than that of PD. By prioritizing PD, the Hong Kong government can allocate healthcare resources more efficiently, ensuring that more patients receive the necessary treatment without overburdening the healthcare system. This approach makes renal care more sustainable in the long term.

What is residual renal function (RRF), and why is its preservation considered crucial in the context of Hong Kong's PD-first policy?

Residual renal function (RRF) refers to the remaining kidney function in patients undergoing dialysis. Its preservation is crucial within Hong Kong's PD-first policy because maintaining even a small degree of kidney function leads to better overall outcomes for dialysis patients. Peritoneal dialysis (PD) is associated with a slower decline in RRF compared to hemodialysis (HD). Preserving RRF contributes significantly to patient health and survival, making PD a preferred option for long-term kidney health management, according to the region's healthcare strategy.

Beyond cost savings, what are the clinical benefits of prioritizing peritoneal dialysis (PD) for patients with end-stage renal disease (ESRD) in Hong Kong?

Beyond cost savings, prioritizing peritoneal dialysis (PD) in Hong Kong offers significant clinical benefits for patients with end-stage renal disease (ESRD). Research indicates that PD patients may experience a survival advantage, particularly during the initial period of dialysis therapy, due to factors such as better preservation of residual renal function (RRF), greater hemodynamic stability, reduced risk of ischemic kidney insult, and lower exposure to inflammatory mediators compared to hemodialysis (HD). These factors collectively contribute to improved patient outcomes and quality of life.