Three years ago, Tran, 70, from Long An, was diagnosed with end-stage chronic kidney disease. She currently undergoes hemodialysis three times a week, with each session lasting 4 hours. To ensure his mother attends appointments on schedule, Tran Nam, a warehouse employee at a shipping company, requested a transfer to the night shift. He typically finishes work in the early morning, rests for a few hours, then drives his mother to the hospital. After three years of waiting for his mother in hospital corridors, he says his heart sinks witnessing many emotional farewells.

Sharing a similar struggle with illness, Lan Anh, 27, from Ho Chi Minh City, was diagnosed with end-stage chronic kidney disease after a long period of fatigue and swollen legs. She requires dialysis three times a week. While health insurance partially covers the cost of dialysis, her family still bears additional expenses for medication, tests, travel, and food, totaling about 4-5 million VND monthly. As she spends most of her time at the hospital, Lan Anh can only work part-time. Her modest income places a financial burden on her parents.

While patients endure physical pain from hemodialysis every two to three days, their families face financial, time, and emotional pressures. *Photo: Pexels*

Another case is Le Van Dung, 39, who also had to change jobs due to his illness. His parents are busy caring for him and earning money. Previously a technician at a gaming company, for the past two years, he has worked as a ride-hailing driver to accommodate his dialysis schedule. Three days a week, he only takes a few morning rides, resting in the afternoon for dialysis. Beyond the costs covered by insurance, Dung spends 3-4 million VND monthly on medication and regular tests.

"To help me afford treatment, my retired parents have taken up tailoring and clothes mending, often working until midnight. My hair has turned gray seeing myself become a burden on my loved ones", Dung said.

Medical experts explain that treating end-stage chronic kidney disease is not only a medical burden but also creates prolonged financial, time, and emotional pressure for families. According to 2025 statistics from the Ho Chi Minh City Society of Nephrology, Vietnam currently has about 12,8% of its population, or over 8,7 million people, suffering from chronic kidney disease. The annual incidence of new cases is about 8,000 people, with the 18-30 age group accounting for 20-30%. The number of people requiring dialysis reaches 800,000, representing 0,1% of the population.

According to the "Inside CKD" study across 11 countries, the annual cost of treating chronic kidney disease amounts to billions of USD, accounting for 2,4-7,5% of national healthcare expenditure. In Vietnam, the health insurance fund pays over 4 trillion VND annually for hemodialysis, highlighting the immense financial burden on patients and society.

Specifically, the cost per dialysis session in Vietnam ranges from 700,000 VND to 2 million VND, depending on the medical facility and individual patient's condition. With health insurance, this amount can be subsidized, with patients paying 150,000-450,000 VND per session. The maximum amount health insurance covers for a single dialysis session is 543,000 VND. Total monthly expenses range from 2,5-12 million VND after insurance coverage, or 12-36 million VND for patients requiring dialysis three times a week without health insurance support.

In this context, to alleviate some of the pressure of caring for end-stage chronic kidney disease patients and the burden on the healthcare system, experts suggest exploring more flexible treatment models. At a scientific seminar organized by the US-ASEAN Business Council (USABC) in Hanoi in January, Paul Uthaichalanond, General Director of Vantive (responsible for the markets of Malaysia, Thailand, Vietnam, and Myanmar), suggested that patients could proactively manage their treatment through home peritoneal dialysis, reducing hospital visits, maintaining their daily routines, work, and family care. He also cited the 2022 NCBI report "Peritoneal Dialysis in the Modern Era," which states that patients undergoing peritoneal dialysis experience higher autonomy, less anxiety, and discomfort compared to hemodialysis, thereby improving their quality of life.

"About 80% of end-stage kidney disease patients are suitable for this method," Paul Uthaichalanond stated. Furthermore, when properly managed, peritoneal dialysis is as effective as hemodialysis, while better preserving residual kidney function, reducing hospitalizations, and serving as a transitional option before kidney transplantation.

Similarly, for children, this method reduces hospital visits, thereby lessening the care burden, preventing malnutrition, and complications from interrupted treatment. Combined with remote patient management software, automated peritoneal dialysis allows medical staff to monitor treatment adherence, clinical indicators, and detect abnormalities early for timely intervention.

Paul Uthaichalanond, General Director of Vantive, responsible for the markets of Malaysia, Thailand, Vietnam, and Myanmar. *Photo: Vantive*

Previously, the "PD First - Start with Peritoneal Dialysis" model was implemented in Thailand in 2008. Paul Uthaichalanond noted that this policy has expanded access to kidney replacement therapy, especially in the country's rural areas. About 70,000 patients have been treated, with 34,000 using continuous ambulatory peritoneal dialysis (CAPD), saving approximately 8,3% of Thailand's health insurance budget.

By 2022, Thailand implemented a "freedom to choose dialysis modality" policy to expand access to hemodialysis. However, this policy led to staffing shortages, reduced quality, and increased mortality rates. After the Health Intervention and Technology Assessment Program (HITAP) evaluated the impact, the Thai government decided to reinstate "PD First" in 4/2025, aiming to balance expanded access, ensure treatment quality, and control costs.

In Vietnam, the widespread implementation of peritoneal dialysis still faces several barriers. Currently, health insurance does not cover medical equipment for outpatient patients, nor does it fully cover the costs of counseling, guidance, and remote patient management.

To sustain and expand home peritoneal dialysis, Paul Uthaichalanond believes there needs to be an appropriate payment mechanism to ensure patient access to treatment and stable care delivery by medical teams. Concurrently, the healthcare system needs close coordination, fostering public-private partnerships, standardizing training, guidance procedures, patient monitoring, and remote supervision applications.

From a corporate perspective, Vantive focuses on several areas of cooperation to help overcome these barriers. With a patient-centric approach, the company prioritizes three key areas: long-term partnership with Vietnam's healthcare system, sharing global experience to develop sustainable and equitable kidney care models; fostering public-private partnerships with central and local hospitals to expand access to home peritoneal dialysis and train medical staff; and applying digital solutions, including remote patient monitoring (RPM) systems and electronic health records, to enhance treatment adherence and ensure continuous care.

"Expanding peritoneal dialysis is also a commitment to social responsibility, aiming to ensure no chronic kidney disease patient is left behind," Paul Uthaichalanond added.

Hieu Chau

* Patient names have been changed.