There is a great deal of variation in the percentage of patients on peritoneal dialysis (PD) around the world. Peritoneal dialysis is growing rapidly in some parts of the world but lagging behind in others. Much of this relates to reimbursement (or lack thereof) for PD relative to hemodialysis (HD) but, in part, it also relates to a lack of expertise in PD (1). In Hong Kong, for example, during the past 20 years in-center HD has doubled while PD has increased 15-fold such that about 80% of dialysis patients are on PD, a model called "peritoneal dialysis first" (2). This increase can be ascribed in part to the healthcare financing of the Hospital Authority of Hong Kong. This organization decided that only PD would be covered unless there was a medical contraindication to PD (3). However, the growth of PD in Hong Kong can also be attributed to the outcomes, which are very good, with low technique failure and good patient survival (2-year patient survival of 83% in all the Hong Kong PD population, and 91% at the Prince of Wales Hospital program) (3). Such outstanding results are due in part to the expertise of the PD team.
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