Peritoneal dialysis for acute kidney injury: techniques and dose.
ABSTRACT It has not been clearly shown which modality of dialysis is superior in the management of acute kidney injury (AKI). Most centers in developed countries have adopted extracorporeal blood purification (EBP) strategies, such as continuous or intermittent forms of hemodialysis or hemofiltration, for the supportive management of AKI. On the other hand, the use of peritoneal dialysis (PD) is widespread in developing countries in view of its ease of use, low cost and minimal requirements on infrastructure. The dose of dialysis required for AKI remains controversial, although an augmented dose with a high small solute clearance is advocated until further definitive evidence becomes available. No studies have directly examined the effects of the dose of PD on outcomes in AKI. The targets of dose for PD are inferred from studies conducted with EBP. There are concerns that PD is unable to achieve high clearances required to support a patient with renal failure. However, various techniques have been described which are able to achieve the targets of small solute clearance. These include high volume PD and continuous flow PD. The selection of flexible peritoneal catheters with better catheter function and dialysate flow rates can improve the efficiency of PD. Other aspects of dose should also be examined, including clearance of middle molecular weight toxins as well as adequate fluid removal. With careful selection of techniques to meet the individual demands of the patient, PD is an appropriate modality of dialysis for patients with AKI.
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ABSTRACT: This paper addresses the epidemiology of AKI specifically in relation to recent changes in AKI classification and revisits the controversies regarding the timing of initiation of dialysis and the use of peritoneal dialysis as a renal replacement therapy for AKI. In summary, the new RIFLE/AKIN classifications of AKI have facilitated more uniform diagnosis of AKI and clinically significant risk stratification. Regardless, the issue of timing of dialysis initiation still remains unanswered and warrants further examination. Furthermore, peritoneal dialysis as a treatment modality for AKI remains underutilised in spite of potential beneficial effects. Future research should be directed at identifying early reliable biomarkers of AKI, which in conjunction with RIFLE/AKIN classifications of AKI could facilitate well-designed large randomised controlled trials of early versus late initiation of dialysis in AKI. In addition, further studies of peritoneal dialysis in AKI addressing dialysis dose and associated complications are required for this therapy to be accepted more widely by clinicians.International journal of nephrology. 01/2011; 2011:762634.