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

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

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Jordan Keane in Health & Wellness November 2026 • 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.

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From Ancient Anatomy to Home Dialysis

The term "peritoneum" derives from the Greek peritonaion, meaning "to stretch around," and the Ebers Papyrus from 1550 BC contains the first known recorded reference to the peritoneal cavity. Historical accounts describe the concept of peritoneal dialysis as nearly a century old, with milestones tracing its development from early observations to renal replacement therapy. In modern practice, peritoneal dialysis is a home-based modality for end-stage kidney disease that can provide flexibility for everyday activities, work, and travel.

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
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Hong Kong's Longstanding PD-First Model

A PubMed-indexed summary reports that Hong Kong established its peritoneal dialysis (PD) first policy in 1985. After 35 years of practice, the policy was described as having influenced countries and governments around the world. This places Hong Kong's approach within a broader international discussion of how dialysis policy can shape health-system practice.

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.

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Technology, Access, and Better PD Care

Recent reviews identify smart medical technologies as an emerging area for peritoneal dialysis, including applications related to training, treatment delivery, and complication identification. Future priorities also include slowing the loss of residual kidney function, treating symptoms of kidney failure pharmacologically, and suppressing inflammation. The current high-dextrose, concentrated acidic solutions used in PD may increase glucose absorption and contribute to peritoneal membrane degradation, creating another target for innovation. The literature identifies inequity of access as the greatest future challenge for the modality.

Cost, Sustainability, and Person-Centred Care

Peritoneal dialysis is described as a well-established and cost-effective form of renal replacement therapy, while kidney failure presents an increasingly common challenge for health-care systems worldwide. A life-cycle assessment reports that home-based PD can offer social, economic, and environmental advantages over haemodialysis, including greater independence, possible cost reductions in some settings, and a smaller environmental footprint. Kidney supportive care adds a person-centred framework in which patients and providers consider individual goals and priorities when making dialysis decisions and revisiting treatment choices over time.

Treatment Failure and Quality of Life

Peritonitis is identified as the primary cause of treatment failure among patients with end-stage kidney disease receiving continuous ambulatory peritoneal dialysis. A case report examining a 62-year-old man highlights the role of dialysis nurses in managing this clinical problem, while also noting that detailed case analyses applying current research remain limited. Decisions about kidney replacement therapy require information about how dialysis may affect daily activities and quality of life, as well as the factors that can change those effects over time.

The modeled cost and effectiveness of first-line dialysis

  • 142,389In a lifetime cost-effectiveness analysis, hospital-based HD cost USD$142,389 and yielded 6.58 QALYs; PD cost USD$76,915 and yielded 7.13 QALYs. The analysis classified HD as dominated by PD.[1]

What the dialysis comparison means-and does not establish

The Hong Kong observational cohort on peritonitis risk cannot by itself establish that the policy caused differences in outcomes: patient selection may also matter, since the policy could favor younger, fitter patients with better-preserved residual kidney function.[2]

Peritonitis can compromise PD and, when severe or repeated, contribute to technique failure and a switch to chronic HD. This shows why a PD-first approach can still require HD support; it does not mean every patient will need to switch.[2] [3]

How costs and evidence vary across settings

The cost comparison is specific to a healthcare-provider perspective, while the South India example counts travel and lost work alongside direct medical care. That broader accounting illustrates why modality costs can look different when patient expenses and time are included.[1] [4]

Costs do not point the same way everywhere: reports from some developing countries describe PD as more expensive than HD, citing labor costs and imported fluids and supplies. The source also notes that many such studies did not specify the cost perspective, limiting direct comparison.[5]

Questions about costs, selection, and switching

  • How much of the observed outcome differences in Hong Kong reflects modality, and how much reflects who is selected for PD under the policy?[2] [6]
  • How do unequal group sizes associated with APD cycler reimbursement affect comparisons of peritonitis risk between APD and other PD care?[2]

Sources

  1. Lifetime cost-effectiveness analysis of first-line dialysis modalities for patients with end-stage renal disease under peritoneal dialysis first policy (pmc.ncbi.nlm.nih.gov)
  2. Risk of first peritonitis episode in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis: a population-based study (pmc.ncbi.nlm.nih.gov)
  3. Renal registry in Hong Kong—the first 20 years (pmc.ncbi.nlm.nih.gov)
  4. How to meet the demand for good quality renal dialysis as part of universal health coverage in resource-limited settings? (pmc.ncbi.nlm.nih.gov)
  5. A Global Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An Opinion (pmc.ncbi.nlm.nih.gov)
  6. Peritoneal dialysis versus haemodialysis for people starting long-term dialysis | Cochrane (www.cochrane.org, 2024)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

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.

2

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.

3

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.

4

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.

5

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.

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