Survey of Practicing Nephrologists in Pakistan: Peritoneal Dialysis Preferences and Reasons for Not Practicing Peritoneal Dialysis

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Background: Peritoneal dialysis (PD) remains underutilized in Pakistan despite being an established, cost-effective renal replacement therapy. This survey evaluated PD practice rates, regional variations, and specific barriers among Pakistani nephrologists domestically and abroad.

Methods: A cross-sectional nationwide survey was conducted among practicing Pakistani nephrologists. Respondent data were analyzed for geographic distribution, current PD practice, and reasons for non-adoption. Statistical comparisons were performed using Fisher's exact test and Chi-square.

Results: Out of 151 respondents n=142 in Pakistan, n=9 overseas), only 38.41%) actively practice PD. Expatriate nephrologists had significantly higher PD uptake than domestic nephrologists. Within Pakistan, significant provincial disparities were observed  with higher practice rates in KPK and Punjab 45.71% and 42.86% respectively.  Primary barriers cited by non-practicing nephrologists included inadequate nursing/technical training 67.03%, lack of surgical support for catheter insertion 62,64% and other issues such as, PD fluid supply issues , patient financial burden , and physician need for retraining.

 Conclusion: PD utilization in Pakistan is severely constrained by structural, educational, and supply-chain bottlenecks. Establishing dedicated interventional training, nursing certification, and national fluid subsidies is critical to achieving PD expansion.