Peritoneal Dialysis in Acute Renal Failure

• Published in: Renal failure Vol. 28; no. 6; pp. 451 - 456
• Main Authors: Ponce Gabriel, Daniela, Nascimento, Ginivaldo Victor R., Teixeira Caramori, Jacqueline, Cuadrado Martim, Luís, Barretti, Pasqual, Luís Balbi, André
• Format: Journal Article
• Language: English
• Published: Colchester Informa UK Ltd 2006; Taylor & Francis
• Subjects: Acute Kidney Injury - therapy; acute renal failure; adequacy; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Emergency and intensive care: renal failure. Dialysis management; Humans; Intensive care medicine; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; peritoneal dialysis; Peritoneal Dialysis - methods; Renal failure; Treatment Outcome; Kidney disease; Extrarenal dialysis; Nephrology; Urinary system disease; acute renal failure; Acute; Renal failure; adequacy; Anesthesia; Peritoneal dialysis; Resuscitation
• ISSN: 0886-022X; 1525-6049
• DOI: 10.1080/08860220600781245

The definition of adequate dialysis in acute renal failure (ARF) is complex and involves the time of referral to dialysis, dose, and dialytic method. Nephrologist experience with a specific procedure and the availability of different dialysis modalities play an important role in these choices. There is no consensus in literature on the best method or ideal dialysis dose in ARF. Peritoneal dialysis (PD) is used less and less in ARF patients, and is being replaced by continuous venovenous therapies. However, it should not be discarded as a worthless therapeutic option for ARF patients. PD offers several advantages over hemodialysis, such as its technical simplicity, excellent cardiovascular tolerance, absence of an extracorporeal circuit, lack of bleeding risk, and low risk of hydro-electrolyte imbalance. PD also has some limitations, though: it needs an intact peritoneal cavity, carries risks of peritoneal infection and protein losses, and has an overall lower effectiveness. Because daily solute clearance is lower with PD than with daily HD, there have been concerns that PD cannot control uremia in ARF patients. Controversies exist concerning its use in patients with severe hypercatabolism; in these cases, daily hemodialysis or continuous venovenous therapy have been preferred. There is little literature on PD in ARF patients, and what exists does not address fundamental parameters such as adequate quantification of dialysis and patient catabolism. Given these limitations, there is a pressing need to re-evaluate the adequacy of PD in ARF using accepted standards. Therefore, new studies should be undertaken to resolve these problems.