讀後心得

The COVID-19 pandemic has prompted a global encouragement for kidney dialysis patients to choose peritoneal dialysis, but the adoption rate in Taiwan is only 8%. Taipei Veterans General Hospital has launched an improved peritoneal dialysis catheter placement surgery, aiming to increase the utilization of peritoneal dialysis. This surgery simplifies the process and shortens the waiting time for patients, allowing for a rapid start of dialysis post-procedure. Peritoneal dialysis is different from hemodialysis; the former can be conducted at home, providing greater flexibility. However, due to a lack of understanding and concerns about the procedure, many patients in Taiwan still prefer hemodialysis. Doctors point out that peritoneal dialysis is simple to perform and has a lower risk of infection, and this method should be better understood and accepted by more people.

The COVID-19 pandemic has promoted countries to encourage dialysis patients to choose peritoneal dialysis, but currently only 8% of patients in Taiwan opt for this method. Why are patients hesitant? Can the innovative peritoneal dialysis catheter placement surgery launched by Taipei Veterans General Hospital improve the shortcomings of emergency dialysis and make peritoneal dialysis the first choice for kidney patients?

Lin Hsin-yi, a 46-year-old dialysis patient, skillfully performs peritoneal dialysis. She is able to conduct automatic dialysis at night and operate it manually during the day. This form of peritoneal dialysis, which is self-administered by the patient, has developed over many years and has become a mature treatment method. Taiwan's incidence and prevalence rate of end-stage renal disease is among the highest in the world, with about 90,000 dialysis patients, but the proportion choosing peritoneal dialysis is only 8%. As a result of the COVID-19 pandemic, peritoneal dialysis can be performed at home compared to regular visits to medical institutions for hemodialysis, reducing hospitalization rates and infection mortality. Therefore, the United States and other Asian countries are promoting this method. Taiwan is also working on improving the adoption rate of peritoneal dialysis from both policy and technical perspectives.

The Deputy Director-General of the National Health Insurance Administration recently announced that a budget of 400 million NTD will be allocated in 2025 to encourage medical institutions to introduce the advantages of peritoneal dialysis to patients and to provide an opportunity for those who have been using hemodialysis for less than two years to switch to peritoneal dialysis. At the same time, the National Health Insurance Administration will also provide 600,000 points of subsidies to promote the establishment of peritoneal dialysis centers in primary care clinics, enhancing professional nursing manpower to help more patients successfully use peritoneal dialysis.

Taipei Veterans General Hospital has improved the peritoneal dialysis catheter placement surgery, allowing end-stage renal disease patients to choose peritoneal dialysis from the beginning of their dialysis journey and reducing wait times. In the past, many patients were reluctant to face the reality of needing dialysis before confirmation, often only seeking medical attention when severe uremic symptoms arise, and typically using hemodialysis as an emergency treatment. In contrast, peritoneal dialysis requires a surgical laparoscopic catheter insertion procedure first and a recovery period of about 14 days for the wound to heal before dialysis can begin. If the surgery cannot be completed in advance, kidney patients may have to resort to hemodialysis during an emergency, thus potentially giving up the option of peritoneal dialysis.

To address the "dual dialysis" issue faced by kidney patients, the attending physician in the nephrology department at Taipei Veterans General Hospital has modified the catheter placement surgery, simplifying it from three laparoscopic kits to one, which reduces the incision size and accelerates recovery time. The research results were published in 2023, and as of early March 2025, 200 kidney patients have undergone this new surgery. Because this innovative procedure allows peritoneal dialysis to be initiated quickly, patients can start dialysis the next day or even on the same day, with fewer complications and a lower incidence of early infections and leaks, which helps increase the choice rate of peritoneal dialysis.

What are the differences between peritoneal dialysis and hemodialysis? Both are treatment options when kidney function fails, and immediate kidney transplantation is not available. Hemodialysis uses machines to filter blood in place of the kidneys, eliminating toxins from the body, while peritoneal dialysis utilizes the peritoneum inside the body for the exchange of uremic substances and fluids. The clearance rates of these two methods are comparable, and both can help patients maintain a normal life. However, hemodialysis is usually performed in medical institutions, whereas peritoneal dialysis can be carried out at home, providing greater flexibility and freedom.

There are still some misconceptions affecting the popularity of peritoneal dialysis. Many kidney patients are skeptical about the operation of peritoneal dialysis, believing it to be complex, especially older patients who often prefer assistance from healthcare personnel, which also results in a higher proportion of younger patients choosing peritoneal dialysis. In reality, the operation of peritoneal dialysis is relatively simple, with almost no barriers; as long as family members assist, even older adults can successfully perform it.

At the same time, many are concerned about the risk of peritonitis, but data shows that the incidence of peritonitis in patients undergoing peritoneal dialysis is significantly lower than that in those undergoing hemodialysis, and most cases are localized infections with relatively low risk. Moreover, reducing the number of visits to medical institutions not only lowers infection risk but also contributes to environmental protection. Therefore, physicians suggest that patients needing dialysis should prioritize peritoneal dialysis to enjoy greater autonomy and freedom.