Peritoneal Dialysis in Acute Kidney Injury: Lessons Learned and Applied

Abstract

Peritoneal dialysis (PD) is a simple, safe, gentle, and efficient renal replacement therapy (RRT) method. It is able to correct acute kidney injury (AKI)-induced metabolic, electrolytic, and acid-base disorders and volume overload both in and out the intensive care unit setting. Some 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 children, patients with refractory heart failure or hemodynamically instable, conditions where systemic anticoagulation should be avoided, patients with difficulty for vascular access and hypo- and hyperthermia conditions. In the following manuscript, PD technical aspects and the possible advantages and limitations of this RRT method will be discussed, and the more recent literature on clinical experience with PD for treatment of AKI will be reviewed.

High-Volume Peritoneal Dialysis in Acute Kidney Injury

“…Our results are similar to the results of previous studies that showed that PD clearance was limited by dialysate flow, membrane permeability, and area (6)(7)(8)(9)(10)(11)(20)(21)(22)(23)(24)(25)(31)(32)(33)(34)(35). A 2-L exchange with a dwell time of 30 minutes can achieve dialysate saturation of around 50%.…”

Peritoneal Dialysis for Acute Kidney Injury

“…Guideline P2.3 -Automated PD Systems: Automated PD employing a cycler was introduced into clinical practice in the 1980s, decreasing the frequency of peritonitis and providing efficient metabolic and electrolyte control in AKI patients (88,89). Automated PD offers a wide selection of highly efficient treatment schedules obtained through the use of short dwell times, high dialysate flows, and customized intraperitoneal volumes (IPVs).…”

Temporary Peritoneal Dialysis in Newborns and Children: A Single-Center Experience over Five Years

“…TPD provides continuously to correct volume and metabolic disturbance without causing hemodynamic instability and it has better cardiovascular tolerance. [17][18][19] Therefore, TPD is a feasible option for the treatment of selected patients with ARF, especially newborns and infants, and those who are hemodynamically compromised and have severe coagulation abnormalities, difficulty in obtaining vascular access, and inborn metabolic disorder. Our reason to choose TPD in our patients was that most of them were newborns and infants who had acute kidney injury and/or inborn metabolic disorders and were hemodynamically unstable.…”