Illustration representing the PD-first policy in Hong Kong, featuring a doctor and patient, with a dialysis machine and a city in the background.

PD First: How Hong Kong's Dialysis-First Policy is Changing Lives and Saving Money

Theo Raines in Health & Wellness June 2025 • 4 min read.

"Discover how Hong Kong's innovative approach to kidney care is setting a global standard, offering hope, and improving outcomes for patients with end-stage renal disease."

In the bustling metropolis of Hong Kong, a groundbreaking healthcare strategy has been quietly transforming the lives of individuals battling end-stage renal disease (ESRD). The city's peritoneal dialysis (PD)-first policy, implemented over three decades ago, has not only improved patient outcomes but also proven to be a financially sound decision, saving the government and society significant costs.

As the prevalence of ESRD continues to rise globally, the need for innovative and cost-effective healthcare solutions is more critical than ever. This article delves into the remarkable success of Hong Kong's PD-first policy, exploring its key components, the challenges it addresses, and its potential to serve as a model for other healthcare systems worldwide.

This approach, emphasizing peritoneal dialysis as the initial treatment for most patients, has resulted in better patient survival rates, improved quality of life, and reduced healthcare expenses. But what exactly is PD-first, and how has Hong Kong achieved such positive results? Let's dive in.

The Pillars of Hong Kong's PD-First Policy: Expertise, Support, and Training

Illustration representing the PD-first policy in Hong Kong, featuring a doctor and patient, with a dialysis machine and a city in the background.

The PD-first policy's success in Hong Kong hinges on several essential elements. First and foremost is the expertise in PD care. This includes skilled medical professionals who can provide appropriate treatment and training to ensure patient safety and optimal outcomes. Support from dedicated staff, including nurses, technicians, and social workers, is also crucial. They provide ongoing care and guidance, helping patients manage their condition and adhere to their treatment plans. A well-designed training program for patients is another critical component, equipping them with the knowledge and skills necessary to perform PD independently at home.

For this strategy to work effectively, Hong Kong's healthcare system has invested heavily in these core elements. By building a robust framework of expertise, support, and training, the city has created an environment where PD patients can thrive. However, specific groups of patients present unique challenges. Let's explore them.

Frequent Peritonitis: PD patients are susceptible to infections, and managing this requires a swift response, appropriate antibiotics, and meticulous attention to hygiene.
Ultrafiltration Failure: Some patients experience difficulties removing excess fluid through dialysis, leading to swelling and other complications. Careful monitoring and adjustments to the dialysis regimen are essential.
Inadequate Dialysis: In some cases, the dialysis may not sufficiently remove waste products from the body. Adjustments to dialysis frequency, volume, or other factors may be necessary.

Addressing these issues is vital to the long-term sustainability of the PD-first policy. Moreover, Hong Kong has incorporated additional strategies, such as encouraging organ donation, which further improves patient outcomes and provides hope for those awaiting transplants.

A Sustainable Future for Kidney Care

Hong Kong's PD-first policy demonstrates that a well-planned and executed healthcare strategy can lead to remarkable improvements in patient outcomes and financial sustainability. By prioritizing peritoneal dialysis, investing in expertise, providing comprehensive support, and addressing specific patient challenges, Hong Kong has created a model for the rest of the world. This policy is not merely a treatment approach; it's a beacon of hope for those living with ESRD, a testament to the power of proactive healthcare, and a step toward a brighter future for kidney care globally.

About this Article -

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Everything You Need To Know

What is Hong Kong's PD-first policy and how does it work?

Hong Kong's PD-first policy prioritizes Peritoneal Dialysis (PD) as the initial treatment for most patients with end-stage renal disease (ESRD). This involves a patient using their own abdominal lining, the peritoneum, as a filter. Patients are trained to perform PD independently at home. The success of this policy relies on three key pillars: expertise in PD care from skilled medical professionals, comprehensive support from dedicated staff like nurses and social workers, and thorough training programs for patients. These components work together to ensure patients can effectively manage their condition and improve their quality of life.

What are the main benefits of the PD-first policy in Hong Kong?

The PD-first policy in Hong Kong offers several significant advantages. It leads to better patient survival rates and improves the quality of life for those with ESRD. It reduces healthcare expenses, making it a financially sound decision for the government and society. Furthermore, the policy emphasizes proactive healthcare by providing expertise, support, and training, creating a supportive environment for patients to thrive and manage their condition effectively.

What challenges do patients face within the PD-first policy, and how does Hong Kong address them?

Patients in the PD-first program can encounter several challenges. Frequent peritonitis, an infection, requires a swift response with antibiotics and strict hygiene. Ultrafiltration failure, the inability to remove excess fluid, necessitates careful monitoring and adjustments to the dialysis regimen. Inadequate dialysis, where waste products are not sufficiently removed, may require alterations in dialysis frequency or volume. Hong Kong addresses these issues through meticulous monitoring, timely interventions, and adjustments to treatment plans, ensuring the long-term sustainability of the PD-first policy.

How does the PD-first policy compare to other treatments for ESRD, and what makes it a cost-effective solution?

Compared to other treatments like hemodialysis, the PD-first policy in Hong Kong offers benefits such as increased patient independence and potentially fewer hospital visits. It proves cost-effective due to several factors. The initial setup costs for PD can be lower than those for hemodialysis. The reduced need for in-center hemodialysis sessions lowers overall healthcare expenses. The improved patient outcomes and quality of life translate to fewer hospitalizations and complications, further reducing costs and the burden on the healthcare system.

What role does organ donation play in Hong Kong's approach to kidney care, and how does it impact the PD-first policy?

Hong Kong actively encourages organ donation as part of its comprehensive approach to kidney care. Organ donation provides a definitive treatment option for ESRD patients, offering them a chance at a longer and healthier life. While the PD-first policy focuses on managing ESRD through peritoneal dialysis, organ donation provides the ultimate goal of a kidney transplant. This integration improves patient outcomes and offers hope for those awaiting transplants, complementing the existing PD-first strategy and creating a brighter future for individuals dealing with kidney disease.