Use of Peritoneal Dialysis in AKI

Abstract

SummaryBackground and objectives The role of peritoneal dialysis in the management of AKI is not well defined, although it remains frequently used, especially in low-resource settings. A systematic review was performed to describe outcomes in AKI treated with peritoneal dialysis and compare peritoneal dialysis with extracorporeal blood purification, such as continuous or intermittent hemodialysis.Design, setting, participants, & measurements MEDLINE, CINAHL, and Central Register of Controlled Trials were searched in July of 2012. Eligible studies selected were observational cohort or randomized adult population studies on peritoneal dialysis in the setting of AKI. The primary outcome of interest was all-cause mortality. Summary estimates of odds ratio were obtained using a random effects model. ResultsOf 982 citations, 24 studies (n=1556 patients) were identified. The overall methodological quality was low. Thirteen studies described patients (n=597) treated with peritoneal dialysis only; pooled mortality was 39.3%. In 11 studies (7 cohort studies and 4 randomized trials), patients received peritoneal dialysis (n=392, pooled mortality=58.0%) or extracorporeal blood purification (n=567, pooled mortality=56.1%). In the cohort studies, there was no difference in mortality between peritoneal dialysis and extracorporeal blood purification (odds ratio, 0.96; 95% confidence interval, 0.53 to 1.71). In four randomized trials, there was also no difference in mortality (odds ratio, 1.50; 95% confidence interval, 0.46 to 4.86); however, heterogeneity was significant (I 2 =73%, P=0.03).Conclusions There is currently no evidence to suggest significant differences in mortality between peritoneal dialysis and extracorporeal blood purification in AKI. There is a need for good-quality evidence in this important area.

Peritoneal Dialysis, Acute Kidney Injury, and the Saving Young Lives Program

“…Peritoneal dialysis, however, continued to be used in low resource settings even though its use was, to some extent, called into question by the randomized trial from Vietnam published in the New England Journal of Medicine in 2002 (2). This study suggested a higher mortality rate for patients with AKI treated with PD compared to hemofiltration; the obvious problems with this study have been discussed previously (3).…”

Peritoneal Dialysis for Acute Kidney Injury

“…If one extrapolates from extracorporeal studies the minimum optimal dose would be a weekly Kt/V of 2.1 (16). Until these 2 doses have been compared head to head, the former should be considered optimal but the latter is the minimum standard.…”

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

“…A systematic review published by Chionh et al 53 concluded that there is currently no evidence to suggest significant differences in mortality between PD and extracorporeal blood purification in AKI and there is a need for good-quality evidence in this important area.…”