Illustration of peritoneal dialysis in Hong Kong

Hong Kong's Kidney Care Revolution: Why 'PD First' Is Saving Lives and Money

Jordan Keane in Health & Wellness November 2025 • 4 min read.

"Discover how a pioneering dialysis policy is transforming healthcare and improving outcomes for patients with kidney disease."

In the bustling city of Hong Kong, a quiet revolution is taking place within its healthcare system. It's a revolution driven by a simple, yet powerful, principle: prioritizing peritoneal dialysis (PD) for patients with kidney disease. This 'PD-first' policy, implemented for over three decades, has not only achieved remarkable success but also serves as a model for other regions grappling with the rising burden of end-stage renal disease (ESRD).

The numbers speak volumes. In Hong Kong, the average cost of hemodialysis (HD) per patient is more than double that of PD. As the prevalence of ESRD continues to rise globally, the financial strain on healthcare systems is immense. This article dives deep into the 'PD-first' policy, exploring its benefits, the challenges it faces, and the innovative strategies that are key to its continued success.

We'll explore why PD is often the preferred initial treatment, the importance of addressing patient issues, and how Hong Kong is enhancing HD support and promoting organ transplantation to ensure the long-term sustainability of this life-saving approach. This comprehensive approach offers not just financial advantages but also offers patients a better quality of life.

The 'PD-First' Policy: A Foundation for Success

Illustration of peritoneal dialysis in Hong Kong

The roots of Hong Kong's 'PD-first' policy trace back to 1969, with the introduction of both maintenance hemodialysis and intermittent PD. However, it was the introduction of continuous ambulatory peritoneal dialysis (CAPD) in 1980 that truly shifted the landscape. CAPD's cost-effectiveness and therapeutic benefits paved the way for PD to become the primary dialysis modality.

Under this policy, all patients with chronic kidney disease requiring dialysis are initially treated with PD, unless specific medical conditions contraindicate it. The Hong Kong Hospital Authority only reimburses HD when medical reasons prevent the use of PD. This approach has led to a remarkable transformation in patient outcomes and healthcare efficiency.

Cost-Effectiveness: PD is significantly less expensive than HD, reducing the financial burden on the healthcare system.
Improved Patient Outcomes: Studies have shown that PD can lead to better patient survival and quality of life.
Home-Based Therapy: PD allows patients to receive treatment at home, promoting independence and reducing hospital visits.
Enhanced Quality of Life: Patients on PD often report better mobility and freedom compared to those on HD.

In 2012, an impressive 72.9% of the dialysis population in Hong Kong was treated with PD, the highest rate globally. This high rate underscores the success of the PD-first approach in making dialysis care more accessible and effective for the majority of patients.

A Model for the Future of Kidney Care

Hong Kong's 'PD-first' policy offers a compelling example of how innovative healthcare strategies can improve patient outcomes, reduce costs, and enhance the overall quality of life. As the global burden of kidney disease continues to rise, the lessons learned from Hong Kong's success story provide valuable insights for healthcare providers, policymakers, and patients worldwide. By prioritizing patient-centered care and embracing the benefits of PD, we can work towards a future where the challenges of ESRD are met with effective, sustainable solutions.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1159/000441580, Alternate LINK

Title: Sustainability Of The Peritoneal Dialysis-First Policy In Hong Kong

Subject: Nephrology

Journal: Blood Purification

Publisher: S. Karger AG

Authors: Agnes Shin-Man Choy, Philip Kam-Tao Li

Published: 2015-01-01

Everything You Need To Know

What is the 'PD-first' policy in Hong Kong, and why is it considered a healthcare revolution?

The 'PD-first' policy in Hong Kong prioritizes peritoneal dialysis (PD) as the initial treatment for patients with chronic kidney disease requiring dialysis, unless there are specific medical contraindications. It's considered a healthcare revolution because it has led to improved patient outcomes, reduced healthcare costs, and enhanced the overall quality of life for individuals with end-stage renal disease (ESRD). Hemodialysis (HD) is reimbursed by the Hong Kong Hospital Authority only when PD is not medically suitable. The policy’s success also lies in its long-standing implementation and continuous adaptation to meet the evolving needs of the patient population.

How does the cost of peritoneal dialysis (PD) compare to hemodialysis (HD) in Hong Kong, and what implications does this have for healthcare sustainability?

In Hong Kong, the average cost of hemodialysis (HD) per patient is more than double that of peritoneal dialysis (PD). This cost difference has significant implications for healthcare sustainability, especially considering the rising global prevalence of end-stage renal disease (ESRD). By prioritizing PD, the 'PD-first' policy helps reduce the financial strain on the healthcare system, allowing resources to be allocated more efficiently. Furthermore, PD's cost-effectiveness doesn't compromise patient care; it often leads to better or comparable outcomes. The economic benefits extend beyond direct treatment costs, impacting hospitalization rates and the need for specialized medical interventions.

What are the key benefits of peritoneal dialysis (PD) over hemodialysis (HD), according to the Hong Kong model?

According to the Hong Kong model, peritoneal dialysis (PD) offers several key benefits over hemodialysis (HD). Firstly, PD is more cost-effective, reducing the financial burden on the healthcare system. Secondly, studies have shown that PD can lead to improved patient survival and enhanced quality of life. Thirdly, PD is a home-based therapy, promoting patient independence and reducing the need for frequent hospital visits. Lastly, patients on PD often report better mobility and greater freedom compared to those on HD. These advantages collectively contribute to a better patient experience and more sustainable healthcare system.

How did the introduction of continuous ambulatory peritoneal dialysis (CAPD) in 1980 contribute to the establishment of the 'PD-first' policy in Hong Kong?

The introduction of continuous ambulatory peritoneal dialysis (CAPD) in 1980 played a pivotal role in establishing the 'PD-first' policy in Hong Kong. CAPD's cost-effectiveness and therapeutic benefits paved the way for peritoneal dialysis (PD) to become the primary dialysis modality. Before CAPD, both maintenance hemodialysis (HD) and intermittent PD were available since 1969, but CAPD made PD more accessible and manageable for patients. This shift allowed for a wider adoption of PD as the initial treatment for chronic kidney disease, leading to the formalization of the 'PD-first' policy where HD is typically only used when medical reasons prevent PD.

Besides prioritizing peritoneal dialysis (PD), what other strategies are being implemented in Hong Kong to ensure the long-term success and sustainability of kidney care?

In addition to prioritizing peritoneal dialysis (PD) through the 'PD-first' policy, Hong Kong is implementing several other strategies to ensure the long-term success and sustainability of kidney care. These include enhancing hemodialysis (HD) support for patients who cannot undergo PD, promoting organ transplantation to provide a permanent solution for end-stage renal disease (ESRD), and addressing patient-specific issues to improve adherence and outcomes. These strategies reflect a comprehensive approach to kidney care, focusing not only on the initial treatment modality but also on providing a range of options and support services to meet the diverse needs of patients with kidney disease. The goal is to offer patient-centered care that maximizes quality of life and optimizes healthcare resource utilization.