The standard for PD is essentially similar to that for HD, except that it is recommended that preparation for PD is commenced a little earlier. There are Proteasome inhibitor other guidelines relevant to commencement of dialysis, specifically concerning the mode of dialysis at initiation and pre-dialysis education. CARI5 suggests that the main determinants of dialysis modality choice are preference of a fully informed patient, absence of medical

and surgical contraindications and resource availability. In the absence of these imperatives, it is suggested that CAPD (but not automated PD) be considered in preference to haemodialysis. The main reasons for preferring PD are the greater ease to commence with incremental dialysis and the better preservation of residual renal function. In addition, there may be an advantage in delaying vascular access, less post-transplant delayed graft function and possibly improved early survival. Within Asia, the approach

to dialysis initiation varies greatly from country to country. For example, Hong Kong has adopted a ‘peritoneal dialysis first’ (PD-first) policy which is regarded as an important contributor to the success of its dialysis program. The relative costs of dialysis check details vary greatly among countries; in Hong Kong the substantially lower annual cost of PD than chronic HD is thought

to be a major reason for the success of their PD-first policy. In the early 1980s, two charity organizations (The Hong Kong Kidney Foundation and the Hong Kong Kidney Patients Trust Fund (HKKPTF)) were established Tobramycin to subsidize the costs of CAPD and in selected patients automated PD (APD). In addition, HKKPTF subsidizes the purchase of ultraviolet disinfection devices. This provision of APD and ultraviolet disinfection are seen as important reasons for dramatic decreases in the rate of PD peritonitis in Hong Kong. There are also recommendations about pre-dialysis education. These stress the importance of informed decision making by patients and their families and carers, the value of multidisciplinary clinics with input from medical, nursing and allied health personnel using standardized protocols, and the value of pre-dialysis education. Many renal units in Asia and worldwide have adopted a structured approach to pre-dialysis care. For example, at Westmead Hospital (Sydney), patients with stage 3b disease (GFR 30–45 mL/min per 1.73 m2) are managed in a ‘healthy kidney’ clinic where the accent is on mitigation of cardiovascular risk and prevention of CKD progression. During this time, patients are given written information about care during the pre-dialysis period, as well as dialysis and transplantation.