Diaverum plans to increase peritoneal dialysis use among patients with ESRD

Diaverum, one of the world's leading renal care providers, is planning to give more patients the possibility to be treated with peritoneal dialysis to increase their quality of life. Peritoneal dialysis is the preferred treatment option for patients who either have problems with vascular access for haemodialysis or have a cardiovascular system not tolerating haemodialysis. It also offers patients who live far away from haemodialysis clinics and who prefer to be flexible and independent from clinic opening hours a good alternative. Currently Diaverum is treating 2 % of its patients with peritoneal dialysis; the target is to increase this percentage to 7 % by 2015.

Peritoneal dialysis (PD) is a home therapy treatment form for patients with kidney failure. It uses the patient's peritoneum (http://en.wikipedia.org/wiki/Peritoneum) (the membrane lining the walls of the abdominal cavity) as a filter across which newly infused PD fluid acts to remove waste products and extra fluid accumulated in the blood (http://en.wikipedia.org/wiki/Blood).

"PD can increase quality of life for the patients. They can conduct this treatment flexibly at home without having to spend four hours in a dialysis clinic three times a week. By offering a range of different treatment alternatives for patients with end stage renal disease (ESRD), such as haemodialysis (HD), PD and kidney transplant, we are giving our patients the possibility to choose the treatment that best suits their form of life and their medical condition," commented Dag Andersson, CEO and President of Diaverum.

"We increased the number of PD treatments by 30 % last year and we are planning to grow even stronger — particularly in Poland, Hungary and Argentina where we are seeing a major increase in PD patients."

From a medical point of view, 15-20 % of dialysis patients could be treated with PD. In reality, the worldwide usage and promotion of PD varies from country to country. In Hong Kong, for example, 80 % of end stage renal disease patients are using PD, in Sweden 24 %, in the UK 17 %, while in Austria (9 %), France (7.5 %) and Germany (4.8 %) the commonness of PD is still very low.

Two key reasons hinder the broader expansion. The first concerns the lack of knowledge in many markets. Even though PD is a valid alternative to HD, the vast majority of nephrologists still prefer HD. Studies have shown that when given unbiased and complete information about both dialysis alternatives, 50 % of patients would choose PD. In Diaverum it is a must to inform new patients on the different options of renal replacement therapy so that they participate in their therapy decision, as long as no medical contraindication exists for one specific dialysis modality.

"Increasing the usage of peritoneal dialysis may also reduce the risk of infection for dialysis patients. The risk of infection and its complications is lower with PD than with HD using catheters as vascular access," explained Dr Jose Divino, Vice President Medical Office Home Therapy at Diaverum.

The second obstacle to the expansion of PD is the different reimbursement models in the different countries. Moving more patients to PD may imply a clear financial relief for local health authorities and payers, since the costs for treating a patient with PD are lower than treating with HD. Despite this fact, PD is not yet reimbursed in some countries, but the economic situation in many countries could be a driving force behind the adoption of PD.