High Volume Peritoneal Dialysis for Acute Renal Failure

Abstract

Background Peritoneal dialysis (PD) is still widely used for acute renal failure (ARF) in developing countries despite concerns about its inadequacy. Continuous PD has been evaluated in ARF by analyzing the resolution of metabolic abnormality and normalization of plasma pH, bicarbonate, and potassium. Methodology A prospective study was performed on 30 ARF patients who were assigned to high-dose continuous PD (Kt/V = 0.65 per session) via a flexible catheter (Tenckhoff) and automated PD with a cycler. Fluid removal, pH and metabolic control, protein loss, and patient outcome were evaluated. Results Patients received 236 continuous PD sessions; 76% were admitted to ICUs. APACHE II score was 32.2 ± 8.65. BUN concentrations stabilized after 3 sessions, creatinine after 4, and bicarbonate and pH after 2. Fluid removal was 2.1 ± 0.62 L/day. Creatinine and urea clearances were 15.8 ± 4.16 and 17.3 ± 5.01 mL/minute respectively. Normalized creatinine clearance and urea Kt/V values were 110.6 ± 22.5 L/week/1.73 m2 body surface area and 3.8 ± 0.6 respectively. Solute reduction index was 41% ± 6.5% per session. Serum albumin values remained stable in spite of considerable protein losses (median 21.7 g/day, interquartile range 9.1 – 29.8 g/day). Regarding ARF outcome, 23% of patients presented renal function recovery, 13% remained on dialysis after 30 days of follow-up, and 57% died. Conclusion High-dose continuous PD by flexible catheter and cycler was an effective treatment for ARF. It provided high solute removal, allowing appropriate metabolic and pH control, and adequate dialysis dose and fluid removal. Continuous PD can therefore be considered an alternative to other forms of renal replacement therapy in ARF.

Acute Kidney Injury in Critically Ill Patients: A Prospective Randomized Study of Tidal Peritoneal Dialysis Versus Continuous Renal Replacement Therapy

“…In addition, serum bicarbonate increased to above 20 mEq/L and serum potassium declined to less than 4 mEq/L (Table ) after 3–4 sessions of TPD. As in Ponce's study , we observed a shorter time to recovery of kidney function in patients treated with TPD compared to extracorporeal blood therapy [5 days (IQR 4‐6) days versus 8 days (IQR 7‐10)] for TPD and CVVHDF, respectively ( P < 0.01). In our study, the infectious complications were less common with TPD when compared with CVVHDF.…”

“…Compared with the previous randomized trial of Ponce et al that did not show differences in terms of survival or recovery of renal functions between HD and high‐volume PD, our results demonstrated a remarkable difference in favor of TPD over CVVHDF (survival rates of 69.8% vs. 46.8%, P < 0.01). While Katirtzoglou et al reported BUN levels below 100 mg/dL which were considered satisfactory at that time for patients with AKI treated with continuous PD, Gabriel and colleagues achieved BUN values around 50 mg/dL and creatinine at <4 mg/dL with high volume peritoneal dialysis used for treatment of AKI in the ICU setting. Chitalia et al demonstrated that CPD was able to maintain BUN levels at about 65 mg/dL in mild and moderate hypercatabolic AKI patients from India.…”

“…It is able to correct AKI‐induced metabolic, electrolytic, acid‐base disorders and volume overload in an ICU setting . Aggressive PD modalities, such as high‐volume PD and continuous flow PD, can provide RRT doses and efficiency comparable to extracorporeal blood purification methods . PD is particularly suitable for patients with hemodynamic instability, and in conditions where systemic anticoagulation should be avoided .…”

Outcomes of critically ill adult patients with continuous renal replacement therapy-requiring acute kidney injury in the Free State province of South Africa: the impact of HIV

“…An often-overlooked modality of CRRT in the ICU is peritoneal dialysis (PD). A study conducted in Brazil reported effective treatment of critically ill patients with AKI using high-volume PD [24]. In countries where contemporary modalities of CRRT are not available, highvolume PD may be a good alternative.…”

Automated peritoneal dialysis as a lifesaving therapy in an emergency room: Report of four cases

“…They reported that both methods, CPD and tidal PD, provided an adequate dialysis dose. A Brazilian group has recently published an interesting paper, 6 bringing PD back to the frontline and giving many doctors, in countries with limited resources, the opportunity to treat their patients with a simple and efficacious technique. Gabriel et al 6 concluded in their study that high-dose continuous PD using Tenckhoff PD catheter and APD with a cycler was an effective treatment for ARF, allowing appropriate metabolic and acid-base control as well as adequate dialysis dose and fluid removal.…”