Introduction:
Incidence of cute kidney injury is increasing .and the need of renal replacement therapy (RRT )for AKI also increasing in particular haemodialysis.
In area with limited resources , haemodialysis may be not available also in situation of increasing demand of of RRT and haemodialysis the resources may limited and can not met the demands for example during the era of covid.
Acute peritoneal dialysis ( aPD) is a modality of RRT with equivocal efficacy of HD and continuous renal replacement therapy (CRRT) but its underutilized .
Methods:
There is multiple obstacles in regards to aPD utilization .there is factors related to health care providers (HCP), institutions related factors and patient related factors.
HCP needs both theoretical back ground and practical experience. The theoretical information is widely available with variety of resources including online tools emphasized the evidence benefits in regards to aPD in management of AKI needs RRT . also provide several informative teaching tools .the ISPD guideline published in 2020 provide valuable information and flexible practical approach to aPD .
For practical aspect a simple curriculum with mini fellowship training program should be appropriate to obtain the adequate surgical experience skills for catheter insertion.
Institutional factors mainly related to availability of resources ,although creating aPD program is beyond our discussion in this abstract but the resources needed for establishing aPD in general is much less than HD or CRRT overall minimal infrastructural needed .
Patient factors in general most of patients candidates to HD they are also candidate to aPD with limited cases of relative or absolute contraindication for aPD in particular abdominal surgical cases .on other hand there is conditions where aPD associated with better outcome including and not limitted cardio renal syndrome and liver cirrhosis with ascites, requiring dialysis.
other advantage is the lack of the need of anticoagulation in aPD , were the use of anticoagulation is of clinical concern in coagulopathy patient on HD or CRRT . Furthermore as no dialysis vascular access needed this is of advantage in patients with multiple vascular access problems and vascular stenosis.
In questionnaire conducted in Thailand a country followed PD first program the main three barriers against aPD found to be timely catheter insertion, effectiveness of PD as modality in fluid and solute clearance , and competency of PD catheter insertion.
Results:
In older to build up a well designed effective aPD program we need multidisciplinary team approach including physicians nurses and technicians .collaboration of this MDT team will help to solve all the barriers for aPD program.
first we need to increase awareness among HCP in regards to the aPD as simple effective ,and safe procedure which provide a modality of RRT comparable to all other RRT modality. This information should be in particular explained to ICU and high dependency unit physicians and nurses .to provide them with adequate knowledge to be familiar with performance of aPD .
The main core of aPD program is a well trained physicians this either mainly nephrologists , interventionalist or surgeon who have full training in different type and manoeuvre of PD catheter insertion as well they are well trained in dealing with any surgical or mechanical complications related to catheter insertion.
In addition to the fact that aPD is safe ,effective, and simple procedure. but also its low cost and that make aPD modality attractive for health care policy maker to decrease the burden of health cost. and probably support the aPD as first choice when RRT needed.
Conclusions:
aPD is acceptable and effective modality for treatment for AKI .despite multiple advantage but still underutilized .increase awareness and education for HCP is important to increase utilization of this modality.
aPD is a multidisciplinary team approach needs to assigned team with comprehensive theoretical and practical training .and with well designed program.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.