Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of
chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for
renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As
continuous ambulatory peritoneal dialysis (
CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However,
CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of
CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for
catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for
CAPD. Cost of
CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with
CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of
CAPD programs and increase the use of protocols designed to improve
CAPD outcomes such as insertion of
catheters, treatment of
peritonitis, and treatment of complications associated with
CAPD. Training of nephrology workforce in
CAPD will increase workforce experience and make
CAPD a more acceptable RRT modality with improved outcomes.