Current status of peritoneal dialysis in Korea: Efforts to achieve optimal outcome

Dae Suk Han, Jae Ha Hwang, Duk Hee Kang, Hyun Yong Song, Hyunjin Noh, Sug Kyun Shin, Seoung Woo Lee, Shin-Wook Kang, Kyu Hun Choi, Sung Kyu Ha, Ho Yung Lee

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Since its introduction in 1981, peritoneal dialysis (PD) has become firmly established as an effective mode of renal replacement therapy and serves an increasing patient population in Korea. The latest registry data indicate that about 3700 end-stage renal disease patients are maintained on chronic PD, representing 24.1% of the country's dialysis population. The majority (93.3%) of these patients are on continuous ambulatory peritoneal dialysis (CAPD) using the two-bag disconnect system, while only 3.3% are on automated PD. Under current renal reimbursement policies, most dialysis patients have to pay 20% of dialysis fees. Thus CAPD patients on 4 x 2-L daily exchanges pay about us$200 per month, not including medication and travel costs. Traditionally, most PD centers in Korea have used the 'standard' prescription of 4 exchanges of 2 L of solution for most of their patients. A recent survey of 1467 patients who commenced CAPD in 1997 revealed that 84% of these patients were initially prescribed 4 x 2-L exchanges, while 12% were given a daily volume of 6 L. With this standard prescription, the percentages of Korean CAPD patients initially achieving the adequacy target of Kt/N urea ≥ 2.0 and standardized creatinine clearance (SCCr) ≥ 60 L/week/ 1.73 m 2 , were 74.4% and 82.1%, respectively. It is likely that, among current Korean CAPD patients, a much lower percentage will achieve the clearance targets compared to this initial outcome, but the precise data are not available. However, it is not clear whether the levels of small-solute clearance recommended for optimal PD outcomes, and proposed by the NKF-DOQI guidelines, will bring the expected benefits to Korean patients. Overall survival of Korean PD patients appears to be as good as, or even better than, that in most other countries. Recently, a single large PD center reported patient survival of 92.1%, 85.6%, 81.4%, and 67.6% at 1, 2, 3, and 5 years respectively. Other centers also reported similar outcomes. As in other countries, cardiovascular deaths predominate among Korean patients: death was due to cardiac causes in 29%, to vascular causes in 21%, and to infectious causes in 24%. Peritonitis is the most important barrier to prolonged use of CAPD in Korea, and more PD patients transfer to hemodialysis because of peritonitis than in other countries. To further reduce the morbidity and mortality of Korean PD patients, various control measures need to be implemented that can reduce or prevent peritonitis and other infectious complications. Also, to further improve long-term patient outcome, Korean nephrologists need to establish and practice optimal clearance targets in the chronic care of these patients.

Original languageEnglish
JournalPeritoneal Dialysis International
Volume19
Issue numberSUPPL. 3
Publication statusPublished - 1999 Dec 1

Fingerprint

Peritoneal Dialysis
Korea
Continuous Ambulatory Peritoneal Dialysis
Peritonitis
Dialysis
Prescriptions
Patient Transfer
Renal Replacement Therapy
Survival
Fees and Charges
Population
Chronic Kidney Failure
Blood Vessels
Registries
Renal Dialysis
Urea

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Han, D. S., Hwang, J. H., Kang, D. H., Song, H. Y., Noh, H., Shin, S. K., ... Lee, H. Y. (1999). Current status of peritoneal dialysis in Korea: Efforts to achieve optimal outcome. Peritoneal Dialysis International, 19(SUPPL. 3).
Han, Dae Suk ; Hwang, Jae Ha ; Kang, Duk Hee ; Song, Hyun Yong ; Noh, Hyunjin ; Shin, Sug Kyun ; Lee, Seoung Woo ; Kang, Shin-Wook ; Choi, Kyu Hun ; Ha, Sung Kyu ; Lee, Ho Yung. / Current status of peritoneal dialysis in Korea : Efforts to achieve optimal outcome. In: Peritoneal Dialysis International. 1999 ; Vol. 19, No. SUPPL. 3.
@article{ae4dba5ea3614d02a7684bbcb81ab94a,
title = "Current status of peritoneal dialysis in Korea: Efforts to achieve optimal outcome",
abstract = "Since its introduction in 1981, peritoneal dialysis (PD) has become firmly established as an effective mode of renal replacement therapy and serves an increasing patient population in Korea. The latest registry data indicate that about 3700 end-stage renal disease patients are maintained on chronic PD, representing 24.1{\%} of the country's dialysis population. The majority (93.3{\%}) of these patients are on continuous ambulatory peritoneal dialysis (CAPD) using the two-bag disconnect system, while only 3.3{\%} are on automated PD. Under current renal reimbursement policies, most dialysis patients have to pay 20{\%} of dialysis fees. Thus CAPD patients on 4 x 2-L daily exchanges pay about us$200 per month, not including medication and travel costs. Traditionally, most PD centers in Korea have used the 'standard' prescription of 4 exchanges of 2 L of solution for most of their patients. A recent survey of 1467 patients who commenced CAPD in 1997 revealed that 84{\%} of these patients were initially prescribed 4 x 2-L exchanges, while 12{\%} were given a daily volume of 6 L. With this standard prescription, the percentages of Korean CAPD patients initially achieving the adequacy target of Kt/N urea ≥ 2.0 and standardized creatinine clearance (SCCr) ≥ 60 L/week/ 1.73 m 2 , were 74.4{\%} and 82.1{\%}, respectively. It is likely that, among current Korean CAPD patients, a much lower percentage will achieve the clearance targets compared to this initial outcome, but the precise data are not available. However, it is not clear whether the levels of small-solute clearance recommended for optimal PD outcomes, and proposed by the NKF-DOQI guidelines, will bring the expected benefits to Korean patients. Overall survival of Korean PD patients appears to be as good as, or even better than, that in most other countries. Recently, a single large PD center reported patient survival of 92.1{\%}, 85.6{\%}, 81.4{\%}, and 67.6{\%} at 1, 2, 3, and 5 years respectively. Other centers also reported similar outcomes. As in other countries, cardiovascular deaths predominate among Korean patients: death was due to cardiac causes in 29{\%}, to vascular causes in 21{\%}, and to infectious causes in 24{\%}. Peritonitis is the most important barrier to prolonged use of CAPD in Korea, and more PD patients transfer to hemodialysis because of peritonitis than in other countries. To further reduce the morbidity and mortality of Korean PD patients, various control measures need to be implemented that can reduce or prevent peritonitis and other infectious complications. Also, to further improve long-term patient outcome, Korean nephrologists need to establish and practice optimal clearance targets in the chronic care of these patients.",
author = "Han, {Dae Suk} and Hwang, {Jae Ha} and Kang, {Duk Hee} and Song, {Hyun Yong} and Hyunjin Noh and Shin, {Sug Kyun} and Lee, {Seoung Woo} and Shin-Wook Kang and Choi, {Kyu Hun} and Ha, {Sung Kyu} and Lee, {Ho Yung}",
year = "1999",
month = "12",
day = "1",
language = "English",
volume = "19",
journal = "Peritoneal Dialysis International",
issn = "0896-8608",
publisher = "Multimed Inc.",
number = "SUPPL. 3",

}

Han, DS, Hwang, JH, Kang, DH, Song, HY, Noh, H, Shin, SK, Lee, SW, Kang, S-W, Choi, KH, Ha, SK & Lee, HY 1999, 'Current status of peritoneal dialysis in Korea: Efforts to achieve optimal outcome', Peritoneal Dialysis International, vol. 19, no. SUPPL. 3.

Current status of peritoneal dialysis in Korea : Efforts to achieve optimal outcome. / Han, Dae Suk; Hwang, Jae Ha; Kang, Duk Hee; Song, Hyun Yong; Noh, Hyunjin; Shin, Sug Kyun; Lee, Seoung Woo; Kang, Shin-Wook; Choi, Kyu Hun; Ha, Sung Kyu; Lee, Ho Yung.

In: Peritoneal Dialysis International, Vol. 19, No. SUPPL. 3, 01.12.1999.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Current status of peritoneal dialysis in Korea

T2 - Efforts to achieve optimal outcome

AU - Han, Dae Suk

AU - Hwang, Jae Ha

AU - Kang, Duk Hee

AU - Song, Hyun Yong

AU - Noh, Hyunjin

AU - Shin, Sug Kyun

AU - Lee, Seoung Woo

AU - Kang, Shin-Wook

AU - Choi, Kyu Hun

AU - Ha, Sung Kyu

AU - Lee, Ho Yung

PY - 1999/12/1

Y1 - 1999/12/1

N2 - Since its introduction in 1981, peritoneal dialysis (PD) has become firmly established as an effective mode of renal replacement therapy and serves an increasing patient population in Korea. The latest registry data indicate that about 3700 end-stage renal disease patients are maintained on chronic PD, representing 24.1% of the country's dialysis population. The majority (93.3%) of these patients are on continuous ambulatory peritoneal dialysis (CAPD) using the two-bag disconnect system, while only 3.3% are on automated PD. Under current renal reimbursement policies, most dialysis patients have to pay 20% of dialysis fees. Thus CAPD patients on 4 x 2-L daily exchanges pay about us$200 per month, not including medication and travel costs. Traditionally, most PD centers in Korea have used the 'standard' prescription of 4 exchanges of 2 L of solution for most of their patients. A recent survey of 1467 patients who commenced CAPD in 1997 revealed that 84% of these patients were initially prescribed 4 x 2-L exchanges, while 12% were given a daily volume of 6 L. With this standard prescription, the percentages of Korean CAPD patients initially achieving the adequacy target of Kt/N urea ≥ 2.0 and standardized creatinine clearance (SCCr) ≥ 60 L/week/ 1.73 m 2 , were 74.4% and 82.1%, respectively. It is likely that, among current Korean CAPD patients, a much lower percentage will achieve the clearance targets compared to this initial outcome, but the precise data are not available. However, it is not clear whether the levels of small-solute clearance recommended for optimal PD outcomes, and proposed by the NKF-DOQI guidelines, will bring the expected benefits to Korean patients. Overall survival of Korean PD patients appears to be as good as, or even better than, that in most other countries. Recently, a single large PD center reported patient survival of 92.1%, 85.6%, 81.4%, and 67.6% at 1, 2, 3, and 5 years respectively. Other centers also reported similar outcomes. As in other countries, cardiovascular deaths predominate among Korean patients: death was due to cardiac causes in 29%, to vascular causes in 21%, and to infectious causes in 24%. Peritonitis is the most important barrier to prolonged use of CAPD in Korea, and more PD patients transfer to hemodialysis because of peritonitis than in other countries. To further reduce the morbidity and mortality of Korean PD patients, various control measures need to be implemented that can reduce or prevent peritonitis and other infectious complications. Also, to further improve long-term patient outcome, Korean nephrologists need to establish and practice optimal clearance targets in the chronic care of these patients.

AB - Since its introduction in 1981, peritoneal dialysis (PD) has become firmly established as an effective mode of renal replacement therapy and serves an increasing patient population in Korea. The latest registry data indicate that about 3700 end-stage renal disease patients are maintained on chronic PD, representing 24.1% of the country's dialysis population. The majority (93.3%) of these patients are on continuous ambulatory peritoneal dialysis (CAPD) using the two-bag disconnect system, while only 3.3% are on automated PD. Under current renal reimbursement policies, most dialysis patients have to pay 20% of dialysis fees. Thus CAPD patients on 4 x 2-L daily exchanges pay about us$200 per month, not including medication and travel costs. Traditionally, most PD centers in Korea have used the 'standard' prescription of 4 exchanges of 2 L of solution for most of their patients. A recent survey of 1467 patients who commenced CAPD in 1997 revealed that 84% of these patients were initially prescribed 4 x 2-L exchanges, while 12% were given a daily volume of 6 L. With this standard prescription, the percentages of Korean CAPD patients initially achieving the adequacy target of Kt/N urea ≥ 2.0 and standardized creatinine clearance (SCCr) ≥ 60 L/week/ 1.73 m 2 , were 74.4% and 82.1%, respectively. It is likely that, among current Korean CAPD patients, a much lower percentage will achieve the clearance targets compared to this initial outcome, but the precise data are not available. However, it is not clear whether the levels of small-solute clearance recommended for optimal PD outcomes, and proposed by the NKF-DOQI guidelines, will bring the expected benefits to Korean patients. Overall survival of Korean PD patients appears to be as good as, or even better than, that in most other countries. Recently, a single large PD center reported patient survival of 92.1%, 85.6%, 81.4%, and 67.6% at 1, 2, 3, and 5 years respectively. Other centers also reported similar outcomes. As in other countries, cardiovascular deaths predominate among Korean patients: death was due to cardiac causes in 29%, to vascular causes in 21%, and to infectious causes in 24%. Peritonitis is the most important barrier to prolonged use of CAPD in Korea, and more PD patients transfer to hemodialysis because of peritonitis than in other countries. To further reduce the morbidity and mortality of Korean PD patients, various control measures need to be implemented that can reduce or prevent peritonitis and other infectious complications. Also, to further improve long-term patient outcome, Korean nephrologists need to establish and practice optimal clearance targets in the chronic care of these patients.

UR - http://www.scopus.com/inward/record.url?scp=0033408434&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033408434&partnerID=8YFLogxK

M3 - Article

C2 - 10433548

AN - SCOPUS:0033408434

VL - 19

JO - Peritoneal Dialysis International

JF - Peritoneal Dialysis International

SN - 0896-8608

IS - SUPPL. 3

ER -

Han DS, Hwang JH, Kang DH, Song HY, Noh H, Shin SK et al. Current status of peritoneal dialysis in Korea: Efforts to achieve optimal outcome. Peritoneal Dialysis International. 1999 Dec 1;19(SUPPL. 3).