Editor’s Pick: Urgent Start Peritoneal Dialysis: A Viable Option for Acute and Chronic Kidney Failure

In this edition’s Editor’s Pick, Ponce et al. tackle the various complexities of urgent-start peritoneal dialysis in both acute and chronic kidney failure in light of the current use of haemodialysis, extending their study beyond the controversies and limitations of its use. This in-depth review focusses on the available evidence and guidelines for unplanned chronic dialysis in acute kidney injury, and combines the available evidence to provide a suitable guide to safely prescribing, delivering, and monitoring high volume peritoneal dialysis in patients.

*Daniela Ponce, Dayana Bittencourt Dias, Andre Luis Balbi

Botucatu School of Medicine, Sao Paulo, Brazil
*Correspondence to dponce@fmb.unesp.br

Disclosure: Daniela Ponce has received a research grant from the Baxter Healthcare Corporation. Dayana Bittencourt Dias and Andre Luis Balbi have declared no conflicts of interest.
Received: 21.10.15 Accepted: 12.02.16
Citation: EMJ. 2016;1[2]:26-33.

Abstract

Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to haemodialysis, not only in the chronic setting, but also in the acute. Recently, interest in using PD to manage acute kidney injury (AKI) patients has been increasing. Some Brazilian studies have shown that, with careful thought and planning, critically ill patients can be successfully treated with PD. To overcome some of the classic limitations of PD use in AKI, such as a high chance of infectious and mechanical complications, and no control of urea, potassium, and bicarbonate levels, the use of cycles, flexible catheters, and a high volume of dialysis fluid has been proposed. This knowledge can be used in the case of an unplanned start on chronic PD and may be a tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy. PD should be offered in an unbiased way to all patients starting unplanned dialysis, and without contraindications to PD. In the following manuscript, advances in technical aspects and the advantages and limitations of PD will be discussed, and recent literature on clinical experience with PD use in the acute and unplanned setting will be reviewed.

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