讀後心得

The COVID-19 pandemic has encouraged countries to promote peritoneal dialysis, but only 8% of patients in Taiwan choose this treatment. Can the improved catheter implantation surgery at Taipei Veterans General Hospital serve as an incentive to increase the adoption rate of peritoneal dialysis? 46-year-old Lin Hsin-Yi is skilled in operating peritoneal dialysis, a method that has been developed for many years and can be done at home. However, due to the impact of the pandemic, peritoneal dialysis has revealed advantages in reducing hospitalization and infection risks compared to hemodialysis. The National Health Insurance Administration of Taiwan plans to allocate 400 million Taiwan dollars in 2025 to encourage medical institutions to promote peritoneal dialysis, helping more patients understand its benefits. The improved surgery shortens the operation and healing time, allowing patients to utilize peritoneal dialysis earlier and increasing flexibility and convenience in their choices. Although peritoneal dialysis is simple and easy to perform, many patients still choose hemodialysis due to fear and misunderstandings. Experts emphasize the need to strengthen awareness and education about peritoneal dialysis.

The COVID-19 pandemic has prompted countries to encourage dialysis patients to choose peritoneal dialysis, but Taiwan's adoption rate is only 8%. Why are patients hesitant? Has the innovative peritoneal dialysis catheter placement surgery at Taipei Veterans General Hospital improved the drawbacks of emergency dialysis, providing an opportunity for peritoneal dialysis to become the preferred choice for renal replacement therapy?

Wearing a mask and washing her hands, 46-year-old dialysis patient Lin Hsin-Yi skillfully unpacks a dialysis solution bag and connects the tubing to the catheter on her abdomen. Since being informed by her doctor that she needed dialysis, she has been able to easily perform peritoneal dialysis for four years, whether through machine operation at night or manual operation during the day. This patient-driven peritoneal dialysis treatment method has developed over many years and has become a mature option.

Taiwan has long had the highest incidence of end-stage kidney disease and prevalence of dialysis in the world, with approximately 90,000 dialysis patients, but the proportion of patients opting for peritoneal dialysis is only 8%. However, with the spread of the COVID-19 pandemic, peritoneal dialysis, which can be completed at home, has not only reduced hospitalization and infection mortality rates compared to hemodialysis conducted in medical facilities, but many countries have also begun to actively promote this treatment. Taiwan is also actively trying to change this trend through policy and technology.

The Deputy Director of the National Health Insurance Administration recently announced plans to allocate 400 million Taiwanese dollars by 2025 to encourage medical institutions to help patients understand the advantages of peritoneal dialysis and provide opportunities for patients who have been on hemodialysis for less than two years to switch to peritoneal dialysis. In addition, the National Health Insurance Administration has offered a subsidy of 600,000 points to promote the establishment of peritoneal dialysis centers in primary care clinics and to enhance the staffing of professional nurses to support more patients in successfully using peritoneal dialysis.

Taipei Veterans General Hospital has improved the peritoneal dialysis catheter placement surgery, allowing end-stage kidney disease patients to choose peritoneal dialysis at the onset of dialysis, avoiding a long waiting period. This innovative surgery simplifies the previous requirement of using three laparoscopic kits into one, resulting in smaller wounds and faster recovery. The research results have been published in 2023, and as of early March 2025, 200 patients have undergone this new surgery.

This innovation allows peritoneal dialysis to be initiated quickly; patients can start peritoneal dialysis the next day or even on the same day, with fewer surgical complications and a lower incidence of early infections and leaks, making it more convenient for patients to opt for peritoneal dialysis, thus helping to increase its popularity.

The main difference between peritoneal dialysis and hemodialysis is that both are treatment options for kidney failure. Hemodialysis filters blood through a machine to remove uremic toxins, while peritoneal dialysis uses the human peritoneum, aided by the dialysis catheter and dialysis solution, to exchange uremic substances, earning it the nickname "washing the belly." Both methods have similar clearance rates that help patients maintain a normal life, but hemodialysis is usually performed in hospitals, requiring at least three sessions per week, while peritoneal dialysis can be executed at home, and the frequency can be flexibly arranged based on specific situations.

The director of the nephrology department at Taipei Veterans General Hospital points out that while there is now an option for "home hemodialysis," the high learning curve means that only a few people can perform it at home, making peritoneal dialysis appear simpler. At the same time, peritoneal dialysis also offers two options: "manual washing" and "machine-assisted washing," providing more flexibility compared to hemodialysis.

• Operating location:
  • Peritoneal dialysis - Home
  • Hemodialysis - Hospital
• Operating methods:
  • Peritoneal dialysis - Manual (continuous portable peritoneal dialysis) and machine (fully automated peritoneal dialysis)
  • Hemodialysis - Assisted by machine and nurses
• Dialysis frequency:
  • Peritoneal dialysis - 3 to 5 times/day
  • Hemodialysis - 3 times/week
• Flexibility:
  • Peritoneal dialysis - Highest, easy to carry when going out
  • Hemodialysis - Lowest

For patients requiring dialysis, the autonomy and flexibility of peritoneal dialysis make it a more recommended choice. Although peritoneal dialysis has become a trend for post-pandemic dialysis, its adoption rate in Taiwan remains significantly lower compared to Hong Kong, which shares a similar cultural background.

Experts point out that the public's lack of understanding of peritoneal dialysis is the main reason for this, with two major misconceptions being particularly prominent. On one hand, while peritoneal dialysis can be performed independently, many elderly patients fear they cannot manage it and prefer to choose hemodialysis performed by healthcare personnel; on the other hand, many people have concerns about the risk of peritonitis and often hesitate at the last moment. Actual data shows that the infection rate for peritoneal dialysis is lower than for hemodialysis, and reducing the number of medical visits helps lower the infection risk.