The Guangzhou Model of Peritoneal Dialysis Care: A Scalable Hub-and-Satellite Network

Chronic kidney disease and end-stage renal disease pose growing challenges to health systems worldwide, particularly in settings where access to high-quality peritoneal dialysis (PD) services remains variable. In response to persistent gaps in primary care-level quality control in China, this study evaluated the implementation of the Guangzhou model, a hub-and-satellite collaborative PD network led by the First Affiliated Hospital of Sun Yat-sen University, with a focus on its impact on service accessibility and long-term clinical outcomes. Using a multicenter retrospective cohort design, the authors examined network expansion across 122 satellite centers and evaluated clinical outcomes in a subset of 15 representative centers with stable longitudinal follow-up data. Survival outcomes among patients treated between 2015 and 2025 were analyzed using Kaplan-Meier methods and compared with national reference standards. Network expansion was associated with substantial improvements in patient retention and a marked increase in dialysis duration. Under a standardized management and training framework, satellite centers within Guangdong Province achieved survival and complication control outcomes that approached those of the central hub. Long-term clinical outcomes at these centers were generally better than national averages, suggesting that care quality was maintained despite rapid scale-up. Overall, the Guangzhou model suggests that standardized training, continuous quality improvement, and digital support can facilitate the large-scale decentralization of high-quality PD services, offering a practical and scalable approach to addressing inequities in access to renal replacement therapy.