ACUTE PERITONEAL DIALYSIS IN THE MANAGEMENT OF ACUTE KIDNEY INJURY AND ACUTE ON CHRONIC KIDNEY DISEASE IN A TERTIARY CARE HOSPITAL IN NORTH-EAST INDIA.

Introduction:

Renal Replacement Therapy (RRT) is a life-saving procedure in management of acute kidney injury (AKI) and acute-on-chronic kidney disease (ACKD). There has been a plethora of techniques devised for RRT including intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), and other hybrid techniques like slow low efficiency dialysis (SLED). These techniques aim to cater to the specific needs of the patient as per their hemodynamic profile. However, the prohibitive cost-of-treatment of these methods limit their widespread availability in developing countries. The aim of this study was to assess the effectiveness, associated complications, and mortality rate of acute peritoneal dialysis (PD), which is cheaper by around a factor of ten, in patients suffering from various etiologies leading to acute kidney injury (AKI) and acute-on-chronic kidney disease (ACKD).

Methods:

This was an observational retrospective single-center study. The study sample consisted of 131 patients treated in the ICU setting of a tertiary care hospital in North-east India between July 2023 till June 2024. Each patient underwent manual acute PD using rigid catheter. The evaluated outcomes included in-hospital survival, renal recovery, metabolic and fluid control rates, as well as technical success rates. Written informed consent was taken from every participating patient and protocols were followed as per Declaration of Helsinki. Unpaired t-Test was used to calculate statistical significance.

Results:

The mean age of the patients was 61.72 + 13.5 years. 92 (70.2%) male and 39 (29.8%) female patients were included in the study. 

Sepsis was the most common etiology for acute PD, accounting for 34.4% of cases, followed by refractory heart failure (30.5%), hepatic failure (25.9%), acute pancreatitis (4.6%), and unknown causes (4.6%). 

The hospital survival rate for patients undergoing acute PD was 67%. Survival differences were linked to the underlying causes of AKI—such as, refractory heart failure, acute pancreatitis, hepatic failure, septic shock, or other causes—as well as the use of inotropes, ventilator support, and the Simplified Acute Physiology Score (SAPS) II. The age of the patient was statistically insignificant (p-value = 0.44) but etiology was statistically significant (p-value = 0.0001) in mortality comparison. 

A significant proportion of survivors (51.1% [45/88]) required maintenance dialysis, primarily due to AKI resulting from heart or hepatic failures. The rates of metabolic and fluid control were 68%, and the technical success rate for acute PD was 93%.

Conclusions:

Acute PD, in developing countries with limited resources, continues to be an effective treatment option for patients with AKI/ACKD with hemodynamic instability, even in the current era of continuous renal replacement therapy (CRRT). Nearly all patients in need of dialysis can undergo acute PD without encountering mechanical difficulties.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.