ASSISTED PERITONEAL DIALYSIS: GLOBAL MODELS, USA LANDSCAPE, AND THE TRANSFORMATIVE ROLE OF MOBILE PHLEBOTOMY AS LAST-MILE DELIVERY

Ranjan Chakraborty*, Mayank Trivedi, Yashvi Patel

Background: Peritoneal dialysis (PD) remains chronically underutilized globally, representing approximately 11% of kidney replacement therapy (KRT) despite demonstrating equivalent or superior clinical outcomes compared to in-centre haemodialysis (HD) for many patient populations. Barriers, including physical frailty, cognitive impairment, caregiver burnout, and psychosocial challenges, prevent a sizeable proportion of eligible patients from initiating or sustaining home-based therapy. Assisted PD (AsPD) programmes—in which trained personnel visit patients at home to support therapy execution—have meaningfully expanded access in Europe, Canada, and Australia. Objective: This paper undertakes a systematic narrative review of: (1) the clinical rationale and outcomes evidence for assisted PD; (2) international models of AsPD delivery across France, Denmark, the United Kingdom, Canada, Australia, China, Brazil, and the United States; (3) the evolving US policy and reimbursement landscape; and (4) the novel proposition of integrating mobile phlebotomy services as the critical last-mile care delivery mechanism for monthly blood draws, exit-site infection surveillance, and PD eligibility support within a US-specific assisted PD model. Methods: A structured literature search was conducted across PubMed, MEDLINE, Nephrology Dialysis Transplantation, the Clinical Journal of the American Society of Nephrology, and policy documents from ISPD, CMS, and USRDS. Studies published between 2010 and 2025 were prioritised, with landmark earlier studies retained for foundational context. Results: Assisted PD has consistently been shown to increase PD initiation rates, expand PD eligibility from 63% to 80% among patients with barriers to self-care, reduce transfers to HD, lower peritonitis rates, reduce hospitalisation, and improve quality of life. International models vary by who provides assistance, how frequently, and through what funding mechanisms. In the United States, a landmark 2022 feasibility study by Hussein et al. demonstrated that patient care technician (PCT)-led assisted PD is operationally viable. A major structural gap remains: Medicare does not yet reimburse assisted PD services, and monthly blood draws for laboratory monitoring continue to require patient travel. Mobile phlebotomy—now deployed at scale in the US by providers such as Quest Diagnostics (with 5,000 phlebotomists in 44 states), myOnsite Healthcare (a nationwide mobile phlebotomy provider with whom the author maintains an advisory engagement), and the National Phlebotomy Provider Network—offers a readily available, scalable mechanism to close this gap by delivering specimen collection, exit-site inspection, and nephrologist eligibility liaison directly to the patient's home. Conclusion: A hybrid model integrating nurse or PCT-assisted PD with mobile phlebotomy services represents a pragmatic, low-capital solution to drive PD initiation, retention, and quality of care in the United States. Policy reforms enabling Medicare reimbursement for both assisted PD visits and mobile phlebotomy specimen collection are the critical enabling steps. Such a model directly supports the ambitions of the 2019 Advancing American Kidney Health Executive Order.