"Peritoneal Dialysis Offers High Patient Satisfaction but Is Overlooked by Hospitals Due to Low Reimbursement"

Assemblywoman Nam Insoon: Increase in Hemodialysis Patients Despite Pilot Program
Vicious Cycle: Diminishing Infrastructure Limits Patient Choice
80% of Nephrologists Say, "Training for Residents, Including Catheter Insertion, Is Insufficient"

Although the government is promoting the "Home-Based Peritoneal Dialysis Management Pilot Project," which allows kidney dialysis patients to undergo dialysis at home without visiting hospitals, the proportion of peritoneal dialysis patients continues to decline every year. Analysts attribute this to hospitals' preference for hemodialysis patients over peritoneal dialysis patients due to insufficient reimbursement rates, leading to the collapse of related infrastructure and reduced training opportunities for medical residents.

Patients with renal failure are undergoing hemodialysis in the dialysis room.

According to data received by Assemblywoman Nam Insoon of the Democratic Party of Korea (Seoul Songpa-gu B) from the Health Insurance Review and Assessment Service, the number of kidney dialysis patients in Korea increased from 60,807 in 2015 to 72,715 in 2019 and 91,185 in 2024. However, the proportion of peritoneal dialysis patients among them steadily decreased from 13.8% to 9.8% and then to 7.7%. In contrast, the proportion of hemodialysis patients increased from 86.2% to 90.2% and then to 92.2% over the same period.

There are two types of dialysis for patients with kidney disease: hemodialysis and peritoneal dialysis. Hemodialysis requires patients to visit the hospital three to four times a week for about four hours per session. Peritoneal dialysis, on the other hand, is a self-administered method performed at home or at work. For peritoneal dialysis, using a machine allows patients to receive dialysis at home for about four hours while sleeping, whereas manual dialysis requires four sessions a day, each lasting 30 to 40 minutes, and can be performed at home, work, or school.

Since December 2019, the Ministry of Health and Welfare has been conducting a pilot project that provides regular management, education, and counseling to help peritoneal dialysis patients safely manage their treatment at home. Currently, 93 medical institutions, including 43 tertiary hospitals, are participating in the project. The project has been evaluated as highly effective, showing reductions in medical costs and utilization among participating patients, improvements in clinical indicators such as decreased exit-site infections and peritonitis, and high patient satisfaction.

The problem is that as the proportion of peritoneal dialysis patients declines year after year, not only is the related infrastructure deteriorating, but the quality of specialist training is also weakening. According to Assemblywoman Nam, the number of peritoneal dialysis patients has continued to decrease, leading Boryung Pharmaceutical, the only domestic manufacturer of peritoneal dialysis equipment, to withdraw from the business in August of this year. As a result, American and German companies now dominate the market. The Korean Society of Nephrology has expressed concern that if the current situation persists, the proportion of peritoneal dialysis patients could fall below 2% within ten years.

In a survey conducted jointly by Assemblywoman Nam and the Korean Society of Nephrology from August 25 to September 5, targeting 112 nephrologists in charge of peritoneal dialysis at hospitals nationwide, 54% responded "No" to the question, "Is peritoneal dialysis education sufficient during the training process (residents and fellows)?" Additionally, 67% answered that the number of hours devoted to peritoneal dialysis education had decreased compared to before. Furthermore, 77% said that trainees' clinical experience with peritoneal dialysis patients had declined compared to previous years, and 80% responded that education on peritoneal dialysis catheter insertion was insufficient.

The main reason for the decline in peritoneal dialysis patients was identified as the issue of reimbursement rates. According to the survey, 71% of respondents cited "insufficient reimbursement" as the biggest obstacle to recommending peritoneal dialysis to patients. This means that doctors in clinical settings are reluctant to recommend peritoneal dialysis due to inadequate reimbursement. From the hospital's perspective, even if they receive the maximum reimbursement under the pilot project, annual income from a peritoneal dialysis patient is less than 1 million won, whereas income from a hemodialysis patient is about 21 million won. In the United States, the proportion of peritoneal dialysis patients, which had dropped to 6% in 2006, increased to 15% by 2022 after reimbursement rates for peritoneal dialysis were raised to match those for hemodialysis in 2011.

Assemblywoman Nam emphasized, "Because hemodialysis patients are more profitable, illegal and irregular practices such as waiving out-of-pocket expenses for patients, providing free meals, patient brokers steering patients, and even buying and selling patients are occurring in the medical field. It is necessary to actively improve the system to promote home-based peritoneal dialysis, which enhances patients' quality of life and reduces medical costs."

This content was produced with the assistance of AI translation services.