The prevalence of Chronic Kidney Disease (CKD) is increasing globally, and it is an issue requiring our urgent attention. In Bangladesh, CKD affects 16-18% of the entire adult population and every year about 40,000 patients develop End Stage Renal Disease (ESRD). In order to sustain life, they need either dialysis or renal transplantation. Renal transplantation facilities are very limited with only a few centers in the capital city. Centers for hemodialysis (HD) are also inadequate and to a few most of them are restricted to around few large cities. As a result, almost 90% of ESRD patients die almost without Renal Replacement Therapy (RRT).

Continuous Ambulatory Peritoneal Dialysis (CAPD) is another mode of dialysis which is much more popular in many countries due to its advantages over HD. Although the practice of CAPD started in 1997 in Bangladesh but it still remains to be popularized. Only 3% of patient on RRT are using this modelity of treatment. Peritoneal Dialysis (PD) has a number of advantages over HD- PD has a 65% lower risk of loss of residual renal function which in turn influences nutrition, cardiovascular function, mineral metabolism, and maintenance of hemoglobin level. So, not only is it sparing residual renal function, it’s also allowing for continued function of other organs.

Peritoneal dialysis has an increased survival rate over hemodialysis, especially during the first two years of dialysis treatment. Other advantages include the fact that it supports a higher hemoglobin level, uses up less erythropoietin, offers better outcome after renal transplantation, allows for better blood pressure and fluid control in elderly patients, and lowers the rate of hospitalization due to infection such as septicemia, pneumonia, and hepatitis B and C. Furthermore, CAPD is a home-based treatment, so there is transporting hassle-free and inexpensive set up, patients have a greater feeling of independence, increased mobility, and an improved quality of life. This is what makes adherence to the program much easier for patients of all categories. It is suitable for all types of patients- including those of extreme ages and those suffering from heart disease.

In spite of such advantages, patients receiving PD in Bangladesh is still less than 2-5%. In order for this PD program to be deemed viable, the prevalence of PD patients should be at least 30% of all ESRD patients on dialysis. Efficacy of the program depends on a strong infrastructure upon which it can expand, but this becomes difficult in Bangladesh due to lack of government cooperation with institutions that are promoting CAPD and lack of knowledge regarding the benefits of CAPD among patients, staff, and even doctors and nephrologists. The high cost of PD fluid, lack of viable treatment modalities for the affected population, and a deficit of networking scopes for training for PD are some other major setbacks.

Fortunately, these obstacles can be overcome by extensive motivational campaigning among nephrologists, medical professionals, nurses, and patients. An integrated approach in collaboration with the government, service providers, and industry will be the keystone to make this program effective. Peritoneal dialysis as a simple RRT can be a more pragmatic treatment modality that can be carried out by properly trained nurses and technicians under the guidance of nephrologists who have experience in PD. By improving nephrologist education, organized patient training, avoidance of PD-related infections, improved management of malnutrition, and increasing active partnerships with the industry will be helpful in broadening the reach of PD.

Bangladesh Society for Peritoneal Dialysis (BSPD) has been established to address the issues positively to make Bangladesh a nation that can adopt PD as a firsthand treatment modality. On behalf of BSPD, I eagerly request all nephrologists, especially the younger nephrologists to come forward and take the initiative to make our mission a success.