KUALA LUMPUR, July 9 — Malaysia should explore integrating peritoneal dialysis (PD) services into existing haemodialysis (HD) centres to expand patient options and strengthen uptake of the Ministry of Health’s PD First policy, experts said at a recent panel discussion.
While PD offers patients greater autonomy, flexibility, and often better quality of life, panellists acknowledged that Malaysia’s renal replacement therapy (RRT) ecosystem remains heavily skewed towards haemodialysis.
Expanding PD availability through HD centres was described as a potential next step to improve access, particularly in the private sector.
“The ecosystem in this country for RRT favours haemodialysis. It is very seamless and very smooth to get patients on haemodialysis. The ordinary JPA (Public Services Department) officer also knows haemodialysis and can approve very fast for application. Same thing with Socso (Social Security Organisation),” said Dr Zaki Morad Mohd Zaher, chairman of the National Kidney Foundation Malaysia, at a symposium on renal replacement therapy organised by the Galen Centre for Health and Social Policy on April 15.
“When it comes to PD, it’s a lot more hassle. Some officers in JPA or Socso do not know what PD is, let alone say automated peritoneal dialysis (APD) versus continuous ambulatory peritoneal dialysis (CAPD). So those things need to be addressed for us to facilitate PD patients.”
Currently, PD is mostly provided in government facilities with established nephrology units. Extending services into private HD centres remains limited due to structural and operational challenges.
Barriers: Nurse Training, Regulatory Compliance, Lack Of Incentives
One of the key barriers identified is the lack of trained personnel in hospitals outside the Ministry of Health to manage PD care. A patient, Raihana Rosman, shared her experience navigating PD services.
“When it comes to public-private partnerships, I feel like, at least for me, I’ve always been to a government hospital because it’s just more convenient for me and it’s also a lot cheaper. It’s just more economical, in my opinion,” Raihana said.
“But from my experience, I was hospitalised at HPUPM (Hospital Sultan Abdul Aziz Shah, UPM) and I found out that the CAPD nurses there even had to seek advice and assistance from the CAPD nurse in Hospital Serdang. HPUPM is a Ministry of Higher Education hospital. What I’m trying to say is that for private hospitals, do they have the same expertise when it comes to PD, to address PD issues as government hospitals?”
Dr Zaki noted that there is “hardly any PD” being done in the private sector, making cost comparisons difficult, unlike for haemodialysis where there is more pricing data.
“The costs charged by hospitals and private health centres for haemodialysis vary widely. It also depends on what services they provide. Some centres only provide certain services, some provide the full range of services. We do lab tests for them, we provide medicine for them. Our cost is about RM200 to RM220 per session. That’s for treatment plus drugs, so it’s a very comprehensive cost, including nutritional advice,” he said.
“Most centres do the washing part only, the haemodialysis, and they don’t do anything else. Patients buy their own medications, do their own blood tests, and those patients sometimes pay about RM180 to RM200.”
Azrul Mohd Khalib, chief executive of the Galen Centre for Health and Social Policy, said that despite the government’s PD First policy, uptake in the private sector remains low due to systemic, financial, and cultural barriers that limit its adoption.
“HD generates higher revenues for private dialysis centres due to frequent, in-centre treatments that incur service fees, equipment charges, and recurring expenses for patient visits,” Azrul said.
In contrast, PD’s home-based nature limits opportunities for private providers to generate consistent income from routine treatments, creating a financial disincentive for its promotion. The absence of government financial support also discourages private centres from investing in PD infrastructure, which involves significant upfront costs for equipment, staff training, and patient support systems.
Reimbursement rates for PD are often lower than for HD, making PD less attractive commercially. “Current funding models favour HD services, discouraging private centres from offering or expanding PD options,” Azrul said.
Financial Incentives, Bundled Payments Could Boost Private Sector PD Adoption
The Galen Centre proposed that financial incentives such as tax breaks, subsidies, revenue-sharing mechanisms for PD consumables, and bundled payment models could help encourage private sector participation and make PD more financially viable for providers.
“A subscription-based peritoneal dialysis framework within the private health care sector has the potential to improve patient access, streamline care delivery, and sustain profitability for service providers,” Azrul said.
“PD is particularly suitable for a structured subscription framework, where recurring services such as supplies, regular check-ups, and telemedicine support) can be integrated into a monthly plan or bundled framework,” he added.
For patients, a subscription-based health care model allows them to better manage their finances by the bundling of essential PD components such as consumables, nursing support, and regular clinical monitoring into a single monthly fee. At the same time, private providers benefit from a stable and predictable revenue stream.
