Peritoneal Dialysis in Anuric Patients: Concerns and Cautions

Abstract

Most recent studies have found an equivalent survival for patients on peritoneal dialysis (PD) and hemodialysis (HD); evidence even suggests that PD might be the preferred modality during the first 3-4 years of renal replacement therapy. This is probably related to the continuous and minimally invasive character of PD as compared to HD, resulting in better preservation of residual renal function (RRF) and less cardiovascular strain. On the other hand, blood pressure control, fluid balance, and adequacy targets may be difficult to obtain in long-term PD patients. The question arises whether PD is a feasible option in anuric patients. It is clear that the answer depends on the body size and the peritoneal membrane transport characteristics of the patient, so that PD will be feasible in some anuric patients, whereas in others it will not be. Evaluation of the peritoneal transport characteristics and adaptation of the PD prescription is warranted. A constant evaluation of the fluid balance, nutritional, and cardiovascular status is needed. This article reviews the physiologic insights and clinical evidence necessary for a good PD prescription in anuric patients.

Emerging Importance of Residual Renal Function in End‐Stage Renal Failure

“…The CANUSA study (43) emphasized the importance of RRF for patients on PD, and a reanalysis of the data using a survival model, which took into account the time‐dependent decline in RRF, demonstrated that RRF was a key factor in survival, rather than dialysis solute clearance (44). The benefits of RRF in PD extend beyond survival and there is good evidence that it has a beneficial effect on anemia (45,46), blood pressure (47), hypervolemia (48), left ventricular hypertrophy (45), nutrition (49,50), and bone metabolism (51).…”

U‐shaped relationship between uric acid and residual renal function decline in continuous ambulatory peritoneal dialysis patients

“…9,10 And beyond survival benefits, RRF has been shown to have beneficial effects on anaemia, blood pressure control, hypervolaemia, left ventricular hypertrophy, bone metabolism and nutrition. [11][12][13][14][15][16] There are many similarities between factors affecting the rate of decline in RRF in dialysis and those affecting the rate of GFR decline in CKD. However, to our knowledge, there is little information on the clinical impact of serum UA levels on the RRF of PD patients.…”

Survival of Functionally Anuric Patients on Automated Peritoneal Dialysis

“…The current guidelines are therefore speculative for anuric patients on PD. Indeed, anuric patients are a difficult group to dialyze effectively using CAPD (7). Not only may membrane permeability increase with time on PD with a consequent decrease in achieved UF (8), but also it is difficult to increase dialysis small solute clearance using CAPD because of the practical difficulties in increasing exchange volume and/or number.…”