Peritoneal Dialysis as First-Line Modality for End-Stage Kidney Disease in Resource-Limited Regions A Prospective Implementation Cohort with Thirty Six Month Follow-up

Dr. Pranay Kumar, Anita Rani, Dr. Nidhi Tyagi

Peritoneal Dialysis; ESKD; PD-First; Technique Survival; Peritonitis; Residual Renal Function; Low-Resource Setting.

Peritoneal dialysis (PD) offers a home-based modality for end-stage kidney disease that is well suited to resource-limited regions where in-centre haemodialysis capacity is constrained. Despite supportive evidence and lower per-patient capital requirements, PD remains under-used in many South Asian centres. We implemented a PD-first programme at a tertiary nephrology service across two years and followed 220 newly diagnosed ESKD patients for up to 36 months 156 who initiated PD and 64 who chose in-centre HD after PD-first counselling. Technique survival at 12 months was 85.9% in PD patients, falling to 61.5% at 36 months as expected for a modality with finite peritoneal membrane viability. Patient survival did not differ significantly between modalities (86.5% PD vs 87.5% HD at 24 months). Residual renal function was preserved substantially better in PD patients, declining from 8.4 to 2.4 mL/min/1.73 m² over 24 months compared with 7.9 to 0.4 mL/min/1.73 m² in the HD group. Peritonitis incidence was 0.42 episodes per patient-year, within accepted international benchmarks. The findings support PD-first as a feasible, outcome-equivalent, and resource-appropriate modality choice in this setting.

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