CHALLENGES OF PERITONEAL DIALYSIS (PD) UNDER VIETNAM’S HEMODIALYSIS-FAVORED POLICY: A NARRATIVE SCOPING REVIEW OF BARRIERS AND POLICY REFORM OPPORTUNITIES

The burden of End-Stage Kidney Disease (ESKD) in Vietnam is rising sharply, pressuring on a health system dominated by in-center hemodialysis (HD). Service capacity and equity remain critical challenges, while peritoneal dialysis (PD), a home-based, cost-effectiveness, and quality of life (QoL)-enhancing modality remains critically underutilized. This study aims to systematically identify, map, and multi-level barriers impeding PD implementation in Vietnam, and to propose feasible policy and system-level reforms to strengthen the national kidney replacement therapy (KRT) framework. 

This narrative scoping review followed the Arksey and O’Malley framework and was reported in accordance with PROSMA-ScR guidelines. A structured search was performed in PubMed, Scopus, and Google Scholar for studies published between 2008 and 2025 using the keywords Vietnam, peritoneal dialysis, hemodialysis, kidney replacement therapy, policy, reimbursement, and infection control. Grey literature was obtained from Vietnamese government websites, National Health Insurance (NHI) circulars, and local conference proceedings. Eligible materials included studies and policy documents addressing KRT utilization, cost-effectiveness, workforce, or system capacity. 5 reviewers independently extracted data on epidemiology, clinical outcomes, economic policy, and health-system organization. Findings were thematically synthesized and categorized into clinical, systemic, and policy-economic domains, and all sources were appraised using a modified Joanna Briggs Institute checklist for narrative and policy analyses.

Although Vietnam’s ESKD prevalence exceeds 80,000 patients, PD penetration remains only 4-7%, while HD accounts for >82%) of all KRT. High peritonitis rates (approximately one episode per 65.6 patient-months) and culture-negative infections continue to undermine confidence in PD safety. A shortage of trained PD personnel and inconsistent follow-up protocols further contribute to HD transfer and poorer outcomes. Evidence from domestic studies demonstrates superior quality of life and lower indirect societal costs among PD patients, yet these data remain poorly translated into reimbursement policy. The national dialysis infrastructure overwhelmingly favors HD, with fragmented pre-dialysis education, unequal geographic distribution of PD services, and inefficient supply chains for PD solutions. At the policy and economic level, the NHI framework provides limited coverage and excludes automated PD machines and consumables, creating no financial incentive for PD adoption. 

Vietnam’s low PD utilization reflects systemic and policy shortcomings rather than clinical limitation. Reform is urgently needed to rebalance the RRT ecosystem through reimbursement realignment that recognizes PD’s long-term economic and social value, national PD workforce development with strengthened infection-control quality programs, and integration of PD education within pre-dialysis counseling and patient-choice frameworks. Drawing on successful regional experiences such as Thailand’s PD-First and Hong Kong’s PD-Preferred models, Vietnam can move toward an equitable, sustainable, and patient-centered dialysis strategy.