Barriers to Peritoneal Dialysis Among Filipino Patients with ESD on Hemodialysis

Background: Peritoneal dialysis (PD) offers advantages over hemodialysis, including better preservation of residual renal function, improved quality of life, and lower risk of bloodstream infections. However, PD uptake remains low. Previously identified barriers—knowledge gaps, sociocultural influences, physical limitations, and medical concerns—vary across countries. Understanding these in the Philippine setting is essential for improving PD adoption. We aimed to determine barriers and associated factors influencing PD uptake among end-stage renal disease (ESRD) patients undergoing hemodialysis, focusing on knowledge, sociocultural, physical, and medical barriers. Methods: A cross-sectional survey was conducted among 382 ESRD patients undergoing hemodialysis at National Kidney and Transplant Institute (NKTI) and nine nearby dialysis centers. A validated interviewer-guided questionnaire assessed barriers to PD across four domains: knowledge, sociocultural, physical, and medical. Logistic regression analysis identified factors associated with each barrier category. Results: Barriers to PD were highly prevalent, with 98% of patients reporting at least one and 79% reporting multiple barriers.Knowledge barriers were most common (89%), followed by sociocultural (79%), physical (60%), and medical barriers (37%). The most frequent knowledge barriers were lack of physician recommendation (62%) and lack of pre-dialysis education (39%). Patients without education on renal replacement therapy had higher odds of knowledge barriers (OR 2.63, p=0.015). Unmarried patients were significantly associated with higher odds of sociocultural barriers (OR 2.7, p = 0.004). Notably, patients who received physician counseling had higher odds of reporting medical (OR 2.12; p = 0.007), sociocultural (OR 4.91; p < 0.001), and physical barriers (OR 3.84; p < 0.001). Conclusion: Knowledge deficits and sociocultural factors are the primary barriers to PD in an urban area in the Philippines. While physician counseling is a central component of pre-dialysis education, its current implementation may be suboptimal. Expanding structured education and counseling are vital to support informed modality choice and improve PD uptake.