Analysis of the Status of Peritoneal Dialysis and Some of its Economical and Medical Aspects

The marginalization of peritoneal dialysis (PD) in Italy has been observed and analyzed more than 10 years ago. The present work reviews this problem concerning PD in Italy as well as worldwide, and evaluates its possible causes on economical and medical bases. The possible relations between the gross domestic product pro-capita (GDP/pC) and the % of PD have been studied based on the prevalence of PD during the years 2007–2008 in 106 countries, associated to the equivalent GDP/pC data by the World Bank. No direct correlation has been found between GDP/pC and % of PD, but there was a clear trend in countries with greater incomes to resort less to PD than the countries with lower incomes. This observation has been better defined by relating the GDP/pC to the % of DP normalized for GDP/pC (PDn): this approach showed an evident and significant difference between countries with greater incomes and those with lower ones, the latter having a DPn share greater than the former ones (among which Italy). In these countries the choice of a dialysis treatment is probably based on different factors than GDP/pC, such as a better reimbursement/cost ratio, and a lesser trust in PD. Some persistent problems concerning the last consideration have been taken into account: the drop out rate, which is still considered in all statistics despite being rather low, and the loss of peritoneal efficiency, due to the reduced, but not yet cut out, damages caused by peritoneal solutions. It is thus possible to believe that the inadequate reimbursements and clinical problems may negatively weigh on the use of PD.