To the Editor:
Peritoneal dialysis (PD) requires less facility-based infrastructure than hemodialysis and can achieve comparable outcomes when supported by trained teams, reliable supplies, and clinical oversight.1 Yet PD accounts for only about 11% of maintenance dialysis worldwide and remains uncommon across sub-Saharan Africa, which has approximately 16% of the global population but less than 1% of the global dialysis population.2 Successful expansion of home dialysis requires coordinated policy, financing, procurement, workforce development, and clinical governance.3 In Ethiopia, maintenance dialysis is limited to hemodialysis and concentrated in Addis Ababa; no chronic PD program exists.4 The readiness of the nephrology workforce to introduce PD has not been assessed.
Between June 1 and 10, 2026, we conducted a census-based cross-sectional survey of all nephrologists practicing in Ethiopia (Supplementary Methods). Of 50 eligible nephrologists, 41 responded (82%). Most were adult nephrologists (88%) and worked in government hospitals (88%); 21 (51%) practiced in Addis Ababa, and 44% had practiced nephrology for 1 to 5 years (Supplementary Table S1 and Supplementary Figure S1).
Exposure to PD was limited. Only 22% rated their PD knowledge as good, and 59% had received no structured PD training. Four respondents (10%) managed patients receiving PD; all were pediatric nephrologists, representing 4 of the 5 pediatric nephrologists surveyed. None had cared for a patient receiving chronic PD for kidney failure. High-barrier ratings clustered around health-system capacity: supply-chain and logistics problems (81%), absence of local PD supply manufacturers (76%), lack of proper training (69%), supply cost (69%), and limited PD catheter availability (64%). Patient-related factors were less often rated as high barriers, including preference for hemodialysis (10%), fear of infection or peritonitis (13%), and religious or cultural beliefs (13%; Figure 1).
Figure 1.
Perceived barriers to implementing peritoneal dialysis among nephrologists in Ethiopia, 2026. Bars represent the percentage of respondents (N = 41) who rated each factor as a high barrier.
Despite limited experience, support for PD was broad. Thirty-three respondents (81%) believed that PD could expand dialysis access, including 32 (78%) who strongly held this view (Supplementary Figure S2). Thirty-two (78%) favored government hospitals as pilot sites, and 40 (98%) were willing to participate in a national PD task force (Supplementary Table S1).
Ethiopia’s immediate PD readiness gap lies primarily in modifiable health-system constraints rather than provider opposition. Experience from public-sector PD-first programs suggests that these barriers can be addressed through government stewardship, stable procurement, and trained multidisciplinary teams.5 The survey also identifies a platform for implementation—broad support for public-sector pilots and near-universal willingness to join a national task force. A phased program should begin in selected government hospitals and prioritize structured training, PD catheter access, uninterrupted dialysate supply, sustainable financing, and clinical governance (Supplementary Discussion; see the Supplementary References,S1–S27).
Disclosure
TK has received consultancy fees from Visterra and AstraZeneca as a country investigator and research funding from the National Research Council of Thailand, and speaking honoraria from AstraZeneca, Alexion Pharmaceuticals, Inc., Fresenius Medical Care, and Baxter Healthcare. The remaining authors declared no competing interests.
Acknowledgments
The authors thank the staff, nurses, and all investigators who contributed to the successful conduct of this study. We also thank the staff of King Chulalongkorn Memorial Hospital, Bangkok, Thailand, for their support in providing peritoneal dialysis training, and gratefully acknowledge the International Society for Peritoneal Dialysis for sponsoring the training program and supporting capacity building in peritoneal dialysis.
Funding
This work was supported by Genomics Thailand, the Health Systems Research Institute (HSRI), Thailand [Grant No. 68-109], and the Thailand Science Research and Innovation Fund, Chulalongkorn University [Grant Nos. HEA_FF_68_018_3000_002 and HEA_FF_69_123_3000_012].
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Author Contributions
WJT and TK contributed to the study conception and design, data collection, data analysis, and interpretation of results. They drafted the initial manuscript, which was reviewed and critically revised by the co-authors for important intellectual content. All authors reviewed and approved the final version of the manuscript and agree to be accountable for all aspects of the work.
Footnotes
Supplementary Methods.
Supplementary Discussion.
Supplementary References.
Figure S1. Frequency distribution of nephrologists in Ethiopia by years of practice, 2026.
Figure S2. Percentage of nephrologists expressing strong belief that PD can expand dialysis access in Ethiopia, by years of service, 2026.
Table S1. Characteristics and peritoneal dialysis experience of survey participants, 2026.
STROBE Checklist.
Contributor Information
Wubshet Jote Tolossa, Email: wubshet96@gmail.com.
Talerngsak Kanjanabuch, Email: golfnephro@hotmail.com, Talerngsak.K@chula.ac.th.
Supplementary Material
Supplementary Methods. Supplementary Discussion. Supplementary References. Figure S1. Frequency distribution of nephrologists in Ethiopia by years of practice, 2026. Figure S2. Percentage of nephrologists expressing strong belief that PD can expand dialysis access in Ethiopia, by years of service, 2026. Table S1. Characteristics and peritoneal dialysis experience of survey participants, 2026. STROBE Checklist.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplementary Methods. Supplementary Discussion. Supplementary References. Figure S1. Frequency distribution of nephrologists in Ethiopia by years of practice, 2026. Figure S2. Percentage of nephrologists expressing strong belief that PD can expand dialysis access in Ethiopia, by years of service, 2026. Table S1. Characteristics and peritoneal dialysis experience of survey participants, 2026. STROBE Checklist.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.