High-Volume Peritoneal Dialysis in Acute Kidney Injury

Abstract

Summary Background and objectives Peritoneal dialysis is still used for AKI in developing countries despite concerns about its limitations. The objective of this study was to explore the role of high-volume peritoneal dialysis in AKI patients in relation to metabolic and fluid control, outcome, and risk factors associated with death. Design, setting, participants, & measurements A prospective study was performed on 204 AKI patients who were assigned to high-volume peritoneal dialysis (prescribed Kt/V=0.60/session) by flexible catheter and cycler; 150 patients (80.2%) were included in the final analysis. Results Mean age was 63.8±15.8 years, 70% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (54.7%). BUN and creatinine levels stabilized after four sessions at around 50 and 4 mg/dl, respectively. Fluid removal and nitrogen balance increased progressively and stabilized around 1200 ml and −1 g/d after four sessions, respectively. Weekly delivered Kt/V was 3.5±0.68. Regarding AKI outcome, 23% of patients presented renal function recovery, 6.6% of patients remained on dialysis after 30 days, and 57.3% of patients died. Age and sepsis were identified as risk factors for death. In urine output, increase of 1 g in nitrogen balance and increase of 500 ml in ultrafiltration after three sessions were identified as protective factors. Conclusions High-volume peritoneal dialysis is effective for a selected AKI patient group, allowing adequate metabolic and fluid control. Age, sepsis, and urine output as well as nitrogen balance and ultrafiltration after three high-volume peritoneal dialysis sessions were associated significantly with death.

Acute kidney injury: risk factors and management challenges in developing countries

“…Dialysis might reduce mortality related to AKI in resource-limited settings, but acute HD is not easily affordable because of the high cost of machines and consumables, unreliable electricity and water supplies, and scarcity of trained personnel. 23 By contrast, gravity-driven PD is a more realistic option because RRT can be delivered without machines and electricity, relying only on consumable supplies, and thus reducing costs and complexity in LRSs. 24 Although particularly useful in areas with fragile health infrastructure, PD is underused in most parts of the world, despite advantages such as reasonable costs (as little as US$150 to save one life) in remote locations.…”

Use of Peritoneal Dialysis in AKI

“…The number of patients, results, and percentages represent only patients who received RRT. Thirteen studies (n=597 patients) were descriptive in nature, in which PD was the only mode of RRT (Table 1) (6,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Three studies compared different subtypes of PD (18,25,26).…”

“…The mean age of patients ranged from 29.1 to 75.6 years. The causes of AKI were variable, with the most common causes being reported as sepsis (10,15,17,18,22,25,(27)(28)(29)(30)(33)(34)(35)(36)(37), prerenal causes or hypovolemia (6,17,22,26,28,30,32,(35)(36)(37), cardiac failure (10,18,22,30,35,36), postsurgery (10,18,19,26,31,35), and nephrotoxic agents (22,26,35,36). Mortality was reported at hospital discharge (6,15,23,35), at 30 days (10,17,18,27), or not specified.…”

“…Details of the PD technique were often not reported. Where data were available, the studies used either rigid catheters (19,26,28,33,35,37) or flexible Tenckhoff catheters (10,15,17,18,21,23,27,34). The automated cycler was used in four studies (10,17,18,23,26,27), and closed drainage systems were commonly used (10,15,17,18,22,23,26,27,37).…”

“…The automated cycler was used in four studies (10,17,18,23,26,27), and closed drainage systems were commonly used (10,15,17,18,22,23,26,27,37). As buffer, lactate (n=10 studies) (10,15,(17)(18)(19)22,23,(25)(26)(27), acetate (n=3) (24,33,37), and bicarbonate (n=1) were used (25). PD dose is discussed separately below.…”