The incidence of acute kidney injury in the elderly has grown over the past decade. One of the primary drivers is drug-induced nephrotoxicity, which is the result of a combination of the unique susceptibilities to kidney injury and the increased use of medications in the elderly population. Specific drug classes are associated with increased rates of kidney injury including agents that block the renin angiotensin system, antimicrobials, and chemotherapeutic agents. Mechanistically, injury may be due to hemodynamic effects, tubular or glomerular toxicity, and interstitial nephritis. Early recognition of nephrotoxicity is critical, as are preventative steps when applicable. Unfortunately, treatment for established drug-induced kidney injury is limited and supportive care is required. Limiting exposure to nephrotoxic drugs is critical in decreasing the incidence of acute kidney injury in the elderly patient.

End-stage renal disease patients with cirrhosis represent a therapeutic dilemma, with several difficulties associated with hemodialysis as a renal replacement therapy modality. Peritoneal dialysis is a feasible option for these patients, despite the confounders of associated infection risk, malnutrition, ascites management, and mechanical complications. This review covers the existing data on the outcomes and complications associated with the use of peritoneal dialysis in the cirrhotic patient.

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End-stage renal disease secondary to autosomal dominant polycystic kidney (ADPKD) is a common issue worldwide. Peritoneal dialysis (PD) is a reasonable option for renal replacement therapy for these patients and should not be withheld due to concerns that the patient may not tolerate the fluid volumes in the peritoneal cavity. This review covers the existing data on the outcomes and complications associated with the use of PD in the polycystic kidney disease patient. In general, PD is well tolerated and outcomes in ADPKD patients are equivalent to or better than other patient groups.

Glucose-based peritoneal dialysis (PD) solutions are the predominantly used dialysate in PD patients. Glucose absorption has been shown to be associated with several unfavorable metabolic complications. Several studies have shown positive effects of exercise in end-stage renal disease patients. This paper provides an overview of glucose-associated metabolic complications, and proposed exercise regimens to counteract the caloric load associated with glucose absorption.