Peritoneal Dialysis Treatment Modality Option in Acute Kidney Injury

Ponce, Daniela; Gobo-Oliveira, Mariele; Balbi, André Luís

doi:10.1159/000452703

Cited by 125 publications

(14 citation statements)

References 24 publications

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“…Studies from these countries have shown that with careful thought and planning, critically ill patients can be successfully treated using PD. Some of the classic limitations of PD use in AKI, such as infectious and mechanical complications and poor metabolic control, have been decreased with the use of cyclers, flexible catheters, and a high volume of dialysate . The relatively good outcomes that have been reported by acute PD programs in low resource settings in the treatment of AKI also contributed to the recent ISPD recommendation that acute PD can be utilized safely and efficiently to treat AKI .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Few studies have discussed the role of peritoneal dialysis (PD) in managing acute kidney injury (AKI) in critically ill patients. The present study compares the outcome of AKI in intensive care unit (ICU) patients randomized to treatment with tidal PD (TPD) or continuous venovenous hemodiafiltration (CVVHDF). One hundred and twenty-five ICU patients with AKI were randomly allotted to CVVHDF, (Group A, N = 62) or TPD, (group B, N = 63). Cause and severity of renal injury were assessed at the time of initiating dialysis. The primary outcome was hospital mortality at 28 days, and secondary outcomes were time to recovery of renal function, duration of stay in the ICU, metabolic and fluid control, and improvement of sensorial and hemodynamic parameters. No statistically significant differences were observed between groups in regard to patients' characteristics. The survival at 28 days was significantly better in the patients treated with TPD when compared to CVVHDF (69.8% vs. 46.8%, P < 0.01). Infectious complications were significantly less (P < 0.01) in the TPD group (9.5%) when compared to the CVVHDF group (17.7%). Recovery of kidney function (60.3% vs. 35.5%), median time to resolution of AKI and the median duration of ICU stay of 9 days (7-11) vs. 19 days (13-20) were all in favor of TPD (P < 0.01). This study suggests that there are better outcomes with TPD compared to CRRT in the treatment of critically ill patients with AKI.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…In addition, it is unclear whether or not the type of post-transplant dialysis modality in renal transplant recipients with DGF affects restoration of renal function, peri-operative complications, or patient and graft survival. Peritoneal dialysis (PD) has several advantages, including wide availability, ease of performance, non-vascular access placement, ability to remove large amounts of fluid in hemodynamically unstable patients, no need for anticoagulation, fewer complications of hemorrhage, and gradual, but effective correction of acid-base and electrolyte imbalance [15]. Compared with PD, hemodialysis (HD) has a higher dialysis efficacy and better capacity control, but a greater impact on hemodynamics and an increased tendency to bleed.…”

Section: Introductionmentioning

confidence: 99%

Hemodialysis or Peritoneal Dialysis, Which Is Better for Patients with Delayed Graft Function?

Yan

Wei

et al. 2018

Kidney Blood Press Res

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Background/Aims: Hemodialysis (HD) or peritoneal dialysis (PD) is an important renal replacement method in patients with delayed graft function (DGF) after kidney transplantation; however, it is not clear which dialysis modality is superior. This study determined the impact of different dialysis modalities on patients with DGF. Methods: It was a single-center, retrospective and descriptive study. We performed 673 kidney transplants from donors after cardiac death (DCD) between January 2010 and December 2016 at our center and 138 (20.5%) recipients developed DGF after transplantation. We classified the recipients into two groups according to post-transplant dialysis: DGF-HD (n=96) and DGF-PD (n=42). We analyzed the outcomes of the different dialysis modalities 30 days and 1 year post-transplantation. Results: There were no differences in baseline factors between patients with post-transplant HD (n = 96) or PD (n = 42). There were 10 patients with conversion from PD to HD during DGF. The DGF-PD patients had a higher rate of treatment failure than the DGF-HD patients (23.8% vs. 0%, p < 0.001), peritonitis (7.1% vs. 0%, p = 0.027), and longer duration of dialysis dependence (10.5 vs. 9 days, p = 0.003). There was no statistically significant difference between both groups with respect to acute rejection, hemorrhage, and patient and graft survival at 1 year. Conclusion: In renal transplant recipients with DGF, post-transplant PD led to increased treatment failure. PD did not result in rapid recovery of transplanted renal function, and had a high probability of peritonitis.

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“…Optimal starting time for kidney replacement therapy Patients with acute renal impairment in intensive care units require enhanced cooperation between doctors and medical technicians of the following specialties: anaesthesiologist intensivists, nephrologists and medical technicians of the general and nephrological intensive care units (37). For treatment of acute kidney damage in critical patients in intensive care units, the following modalities of kidney replacement therapy (renal replacement therapy (RRT)) are used: acute peritoneal dialysis, acute intermittent haemodialysis, and continuous dialysis modalities (continuous venous vein haemodiafiltration (CVVHDF)) (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). Intermittent haemodialysis provides rapid clearance of the substance/electrolyte and a high degree of ultrafiltration.…”

Section: Treatment Of Acute Kidney Damagementioning

confidence: 99%

Acute Kidney Damage: Definition, Classification and Optimal Time of Hemodialysis

Hamzagić¹,

Nikolić

Jovicić

et al. 2019

Serbian Journal of Experimental and Clinical Research

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Acute damage to the kidney is a serious complication in patients in intensive care units. The causes of acute kidney damage in these patients may be prerenal, renal and postrenal. Sepsis is the most common cause of the development of acute kidney damage in intensive care units. For the definition and classification of acute kidney damage in clinical practice, the RIFLE, AKIN and KDIGO classifications are used. There is a complex link between acute kidney damage and other organs. Acute kidney damage is induced by complex pathophysiological mechanisms that cause acute damage and functional disorders of the heart (acute heart failure, acute coronary syndrome and cardiac arrhythmias), brain (whole body cramps, ischaemic stroke and coma), lung (acute damage to the lung and acute respiratory distress syndrome) and liver (hypoxic hepatitis and acute hepatic insufficiency). New biomarkers, colour Doppler ultrasound diagnosis and kidney biopsy have significant roles in the diagnosis of acute kidney damage. Prevention of the development of acute kidney damage in intensive care units includes maintaining an adequate haemodynamic status in patients and avoiding nephrotoxic drugs and agents (radiocontrast agents). The complications of acute kidney damage (hyperkalaemia, metabolic acidosis, hypervolaemia and azotaemia) are treated with medications, intravenous solutions, and therapies for renal function replacement. Absolute indications for acute haemodialysis include resistant hyperkalaemia, severe metabolic acidosis, resistant hypervolaemia and complications of high azotaemia. In the absence of an absolute indication, dialysis is indicated for patients in intensive care units at stage 3 of the AKIN/KDIGO classification and in some patients with stage 2. Intermittent haemodialysis is applied for haemodynamically stable patients with severe hyperkalaemia and hypervolaemia. In patients who are haemodynamically unstable and have liver insufficiency or brain damage, continuous modalities of treatment for renal replacement are indicated.

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Peritoneal Dialysis Treatment Modality Option in Acute Kidney Injury

Cited by 125 publications

References 24 publications

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

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

Hemodialysis or Peritoneal Dialysis, Which Is Better for Patients with Delayed Graft Function?

Acute Kidney Damage: Definition, Classification and Optimal Time of Hemodialysis

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