Peritoneal Dialysis: Allowing Patients to Self-Manage Their Diseases In recent years, chronic diseases have become the leading culprit of human health as disease patterns have changed. WHO officials have said that if nothing is done, 388 million people will die from chronic diseases worldwide in the next decade, including 80 million Chinese, and that heart disease, stroke and diabetes alone will cost China at least $550 billion in economic losses during this period. Thus, it seems imperative to strengthen the prevention and control of chronic diseases. Wang Tao, director of the Department of Nephrology at Peking University Third Hospital, who has been engaged in the research of peritoneal dialysis treatment technology for many years, believes that under the condition of limited national investment, we should actively explore simple, inexpensive and effective prevention and control technology, and at the same time improve the health awareness of patients, so that they can participate in the prevention and control of chronic diseases and become self-managers of diseases, which can effectively fight against chronic diseases and improve the overall health quality of our people In this way, we can effectively fight against chronic diseases and improve the overall health quality of our people, but also get rid of the passive situation of complete dependence on doctors and save medical resources. Wang Tao’s persistent research on peritoneal dialysis technology may bring us some thoughts, people ask the state to increase medical investment is not wrong, but on our national conditions, everything by the state is not achievable, if we can provide some practical, safe, effective, inexpensive treatment technology for the people under the condition of limited resources, is undoubtedly a good thing. The situation of chronic kidney disease treatment in China is serious In recent years, with the change of living environment and lifestyle, the number of patients with chronic kidney disease in China has increased rapidly. According to statistics, the prevalence of chronic kidney disease among people over 40 years old in China has reached 10%, and there may be more than 1 million kidney disease patients in need of dialysis treatment nationwide, yet only about 100,000 people are on maintenance treatment. “Compared with Western countries, the treatment rate of chronic kidney disease in China is still very low.” Wang Tao said that in Japan, the dialysis treatment rate for patients with chronic kidney disease is 1,800/1 million, in Taiwan, China, it is 2,000/1 million, and in Hong Kong, it is 1,400 to 1,600/1 million. If we follow the level of Japan, by 2010, the chronic kidney disease patients who need dialysis treatment in China’s cities and towns alone will reach more than 1 million. With the gradual implementation of urban residents’ medical insurance and new rural cooperative medical care, the dialysis treatment rate of chronic kidney disease in China is increasing, which is a welcome phenomenon. However, Wang Tao pointed out that we cannot ignore that the population of chronic kidney disease patients is still expanding, and the cost of traditional hemodialysis is very high, and a patient who undergoes maintenance treatment needs about 100,000 yuan per year, which most families simply cannot afford. This means that every year, many patients with chronic kidney disease die because they cannot afford it. Peritoneal dialysis is developing in a tortuous way Peritoneal dialysis and hemodialysis are two common dialysis modalities used by patients with chronic kidney disease nowadays. It uses the peritoneum as a semi-permeable membrane and injects peritoneal dialysis fluid into the abdominal cavity through a peritoneal dialysis tube to remove toxins through the diffusion principle, correct electrolyte and acid-base balance disorders, and replace the excretory function of the kidneys through the osmosis principle in order to achieve ultrafiltration and dehydration. Wang Tao said that peritoneal dialysis is not a new thing, it has more than 40 years of development history in foreign countries, and in the 1970s once accounted for about 40% of the entire dialysis population. Related research was also conducted relatively early in China. In the 1960s, Professor Ye Rengao, a famous nephrologist and the founder of peritoneal dialysis treatment in China, started to engage in research on peritoneal dialysis. However, soon after the outbreak of the “Cultural Revolution”, peritoneal dialysis research was forced to stop. In the late 1970s and early 1980s, peritoneal dialysis was developing rapidly, and patients in foreign countries were already able to treat themselves at home, while in China, treatment could only be done in hospitals. At that time, the technology of peritoneal dialysis was not mature, the quality of dialysis fluid was not up to par, and patients often developed infections. After the reform and opening up, especially in the mid to late 1980s, as foreign hemodialysis machines entered the Chinese market, major hospitals purchased a large number of hemodialysis machines and started hemodialysis centers. Because hemodialysis uses machines with high benefits, while peritoneal dialysis uses dialysis fluid with low benefits, resulting in peritoneal dialysis being in the cold. In the 1990s, Baxter (a multinational medical supply company) introduced a large amount of peritoneal dialysis solution into the Chinese market, and the quality of the dialysis solution was guaranteed, reducing the infection rate of patients, and in some places, patients have been able to go home for self-treatment, and the peritoneal dialysis market in China has rebounded, but it still cannot be compared with hemodialysis. ”The reasons for the slow development of peritoneal dialysis in China are manifold, including the failure of its own technology in the early stage, the squeeze of hemodialysis, the lack of awareness of peritoneal dialysis, the lack of relevant technical personnel and so on. Of course, this is also related to the fact that there is a lot of confusion in the international understanding of peritoneal dialysis.” Wang Tao said. Shifting the paradigm to allow patients to manage their disease Although peritoneal dialysis has been moving forward since reform and opening, this development has been slow, so much so that its advantages and features have not really come into play at all. Since 2002, however, peritoneal dialysis has shown accelerated growth in China. Wang Tao says that chronic kidney disease is not curable, and our aim is not to cure the disease, but to keep it from progressing and to be able to work and live normally, so we have changed the original acute disease treatment model to a chronic disease management model by training patients themselves to treat themselves at home and to be self-managers of the disease. Another one is to strengthen the dietary guidance for patients to avoid medically induced changes. In the past, patients ate and drank a lot after peritoneal dialysis treatment, but over time, their kidney function gradually declined and their whole body became swollen due to reduced dehydration, and the lack of attention to this problem for a long time led people to doubt the reliability of peritoneal dialysis. In fact, this medically induced change can be completely avoided as long as the patient eats normally under the guidance of the doctor. After the reform, the advantages of peritoneal dialysis were well unleashed. Compared with traditional hemodialysis, peritoneal dialysis is convenient, simple, and can be performed at home; the treatment is continuous, the status is stable, and the damage to the body is less; it can improve patients’ disease self-management ability and quality of life, reduce complications, and prolong patients’ survival time; more importantly, it reduces the cost, and patients who undergo peritoneal dialysis spend 60,000 to 65,000 yuan per year, which is useful for improving chronic kidney disease patients’ treatment rate is very meaningful. “This reform is a success, and now the number of patients undergoing peritoneal dialysis nationwide has reached 16,000 to 17,000, and 400 patients are currently undergoing peritoneal dialysis at Beihang Hospital alone.” Wang Tao said. Peritoneal dialysis needs urgent policy support Peritoneal dialysis is gaining popularity, Wang Tao is naturally confident, however, he also expressed his concern. Many countries are now vigorously promoting the development of peritoneal dialysis, but our country lacks practical action. There are few dialysis solutions domestically produced, and the quality has always been a problem, and almost all dialysis solutions currently used in major hospitals are products from large foreign medical supply companies; dialysis solution is a drug rather than a device, and the benefits are low, so many hospitals are reluctant to invest in it; in addition, a key part of making peritoneal dialysis a true family treatment is to train patients, which requires hospitals to invest more manpower, and due to the lack of investment, the current The training situation is not optimistic. “I hope the state will give more policy support to make peritoneal dialysis beneficial for more patients with chronic kidney disease.” Wang Tao appealed.