Person using peritoneal dialysis in Hong Kong

Peritoneal Dialysis: How Hong Kong's Innovative Policy is Changing Kidney Care

Lena Voss in Health & Wellness November 2025 • 3 min read.

"Discover how Hong Kong's PD-first policy is improving patient outcomes and reducing healthcare costs."

In Hong Kong, the financial strain of treating end-stage renal disease (ESRD) has led to an innovative healthcare approach. Unlike many Western countries, Hong Kong has championed peritoneal dialysis (PD) as the primary treatment for kidney failure for over three decades.

Why PD first? Peritoneal dialysis offers a practical and cost-effective alternative to hemodialysis (HD). The average annual cost of HD per patient is more than double that of PD, making it a fiscally responsible choice for a healthcare system managing an increasing number of ESRD cases.

With its PD-first policy, Hong Kong has achieved impressive results. In 2012, 72.9% of dialysis patients were treated with PD, the highest percentage globally. This success hinges on dedicated medical expertise, well-trained staff, and comprehensive patient education programs. Let's delve into how this policy works and its impact on patients' lives.

The Pillars of Hong Kong's PD-First Policy: How Does It Work?

Person using peritoneal dialysis in Hong Kong

Hong Kong's PD-first policy operates on a simple yet effective principle: all patients requiring dialysis are first considered for PD unless medical contraindications exist. This approach ensures that the majority of patients benefit from this cost-effective treatment option.

Here’s how the policy is implemented:

Comprehensive Education: All patients receive thorough education about both PD and HD. This ensures they understand their options and can make informed decisions.
Financial Incentives: The Hong Kong Hospital Authority only reimburses HD for patients with medical contraindications for PD. Those who choose HD for personal preferences must cover the costs themselves.
Centralized Planning: Since 1985, the Central Renal Committee has standardized renal services in Hong Kong, ensuring consistent and effective implementation of the PD-first policy.

This structured approach has not only made PD accessible but also sustainable. By prioritizing PD, Hong Kong manages its resources effectively while maintaining high standards of patient care.

Looking Ahead: Maintaining and Improving the PD-First Policy

To maintain the sustainability of the PD-first policy, Hong Kong focuses on several key areas: addressing common PD-related issues, enhancing HD support, and promoting organ donation. By tackling challenges like frequent peritonitis, ultrafiltration failure, and inadequate dialysis, the healthcare system ensures better outcomes for all patients. Ultimately, Hong Kong's PD-first policy serves as a model for other regions facing similar healthcare challenges. Its success demonstrates that prioritizing cost-effective, patient-centered care can lead to significant improvements in public health.

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Everything You Need To Know

What is the primary treatment approach for kidney failure patients in Hong Kong, and how does it differ from Western countries?

In Hong Kong, the primary treatment for kidney failure is peritoneal dialysis (PD), a strategy that differs significantly from many Western countries. While many Western nations may offer hemodialysis (HD) as the primary treatment, Hong Kong has championed PD for over three decades. This 'PD-first' policy prioritizes PD unless medical contraindications exist, ensuring more patients benefit from this cost-effective option.

What are the main reasons behind Hong Kong's decision to adopt a Peritoneal Dialysis (PD)-first policy?

The decision to implement a PD-first policy in Hong Kong was primarily driven by the financial strain of treating end-stage renal disease (ESRD). PD offers a cost-effective alternative to hemodialysis (HD), with the average annual cost of HD being more than double that of PD. This fiscal advantage allows Hong Kong to manage its resources more efficiently, especially with an increasing number of ESRD cases.

How is the Peritoneal Dialysis (PD)-first policy implemented in Hong Kong, and what measures are in place to support it?

The PD-first policy in Hong Kong is implemented through several key measures. Firstly, all patients needing dialysis receive comprehensive education about both PD and hemodialysis (HD), enabling them to make informed decisions. Secondly, financial incentives are in place where the Hong Kong Hospital Authority only reimburses HD for patients with medical contraindications for PD; those who choose HD for personal preferences must cover the costs. Finally, the Central Renal Committee has standardized renal services since 1985, ensuring consistent and effective policy implementation.

What are the advantages of Peritoneal Dialysis (PD) over Hemodialysis (HD) in the context of Hong Kong's healthcare system?

In the context of Hong Kong's healthcare system, Peritoneal Dialysis (PD) offers several advantages over Hemodialysis (HD). Primarily, PD is a cost-effective treatment option, with costs significantly lower than HD. This cost-effectiveness allows Hong Kong to manage its healthcare resources efficiently. Furthermore, PD allows a larger percentage of patients to receive treatment at home, potentially improving quality of life and reducing the burden on hospitals. In addition, the policy's success hinges on dedicated medical expertise, well-trained staff, and comprehensive patient education programs.

What are the key areas of focus for Hong Kong to maintain and improve its Peritoneal Dialysis (PD)-first policy?

To maintain and improve its PD-first policy, Hong Kong focuses on several key areas. These include addressing common issues related to Peritoneal Dialysis (PD), such as frequent peritonitis and ultrafiltration failure, which ensures better outcomes for all patients. Enhancing Hemodialysis (HD) support is another area, providing backup treatment for patients who cannot undergo PD. Promoting organ donation also plays a crucial role, offering an alternative and potentially curative treatment for kidney failure. By addressing these challenges, Hong Kong aims to ensure the sustainability and effectiveness of its PD-first policy, serving as a model for other regions.