讀後心得

The COVID-19 pandemic has prompted a global push for peritoneal dialysis, but only 8% of patients in Taiwan choose this option. The modified peritoneal dialysis catheter surgery at Taipei Veterans General Hospital aims to address the urgent need for dialysis and make peritoneal dialysis the preferred choice. 46-year-old dialysis patient 林欣儀 has successfully undergone peritoneal dialysis for four years, finding this treatment method more flexible for home operation. Taiwan has nearly 90,000 dialysis patients each year, but the prevalence of peritoneal dialysis is low, with one reason being insufficient awareness of it. The National Health Insurance Administration has started to promote peritoneal dialysis and provide subsidies to help patients better understand its advantages. Many kidney patients still worry about the difficulty of operation and infection risks, but experts point out that these issues can be overcome with family support and correct knowledge, which could make peritoneal dialysis a more popular option.

The COVID-19 pandemic has prompted countries to encourage dialysis patients to choose peritoneal dialysis, but in Taiwan, the adoption rate is only 8%. Why are patients hesitant to choose it? Can the innovative peritoneal dialysis catheter implantation surgery at Taipei Veterans General Hospital improve the disadvantages of emergency dialysis and make peritoneal dialysis the first choice for kidney patients?

Lin Hsin-Yi, a 46-year-old dialysis patient, skillfully handles the dialysis solution bags, connecting the tubing to the catheter on her abdomen. Since being diagnosed with kidney failure four years ago, whether it's automatic nighttime dialysis or manual operations during the day, she can easily complete peritoneal dialysis. This type of peritoneal dialysis, performed by patients themselves, is a mature treatment method. Taiwan has the highest rates of end-stage kidney disease incidence and dialysis prevalence globally, with about 90,000 people undergoing dialysis, but only 8% choose peritoneal dialysis.

With the global spread of the COVID-19 pandemic, peritoneal dialysis, which can be completed at home, effectively reduces hospitalization rates and infection mortality compared to the hemodialysis that requires visits to healthcare facilities. As a result, the United States and Asian countries are actively promoting it. Taiwan has also begun to tackle this issue from both policy and technological perspectives.

The Deputy Director of the National Health Insurance Administration announced that a budget of 400 million NTD will be allocated in 2025 to encourage healthcare institutions to educate patients about the advantages of peritoneal dialysis and allow patients who have been on hemodialysis for less than two years to have the opportunity to switch to peritoneal dialysis. At the same time, the National Health Insurance Administration will provide a subsidy of 600,000 points to promote the establishment of peritoneal dialysis centers in primary care clinics, supplementing nursing staff to help more patients successfully use peritoneal dialysis.

The improved peritoneal dialysis catheter implantation surgery at Taipei Veterans General Hospital allows end-stage kidney disease patients to choose peritoneal dialysis early in their treatment, avoiding long waiting times. This innovative surgery enables patients to undergo dialysis more quickly and reduces the risk of surgical complications and early infections.

There are significant differences in the treatment methods between peritoneal dialysis and hemodialysis. Both are treatment options for kidney function failure when an immediate kidney transplant is not possible, but hemodialysis is typically performed at healthcare facilities, whereas peritoneal dialysis can be done at home.

• Peritoneal Dialysis: Can be performed at home by patients and offers more flexibility.
• Hemodialysis: Operated by machines and requires regular visits to the hospital for treatment.

The director of the Department of Nephrology at Taipei Veterans General Hospital stated that although there is now an option for "home hemodialysis," only a few people can perform it at home. Therefore, peritoneal dialysis is simpler and provides both manual and machine options, offering greater flexibility.

Despite peritoneal dialysis becoming a new trend post-pandemic, the usage rate in Taiwan remains lower than in Hong Kong. The main reason is a lack of understanding of peritoneal dialysis.

• First, some patients prefer hemodialysis operated by healthcare professionals due to concerns about age and ability.
• Second, patients have misconceptions about the risk of peritonitis; in reality, peritoneal dialysis is relatively safe with a lower incidence rate.

Reducing the number of hospital visits can lower the risk of infection and also help to reduce environmental impact.