Introduction:
With the advances in renal replacement therapy (RRT), acute peritoneal dialysis (PD) as a treatment modality is rarely used. This study focuses on the outcomes of acute PD in a resource-limited setting.
Methods:
A retrospective observational study was conducted on 101 patients who received acute PD for renal failure which could be acute kidney injury (AKI), acute worsening of chronic kidney disease (CKD), or CKD5. They were admitted to our medical and surgical intensive care and emergency wards from December 2023 to February 2024. The outcomes studied were short-term survival, conversion to Hemodialysis (HD), or complete renal recovery after PD.
A rigid PD catheter was inserted at the bedside by nephrology residents. PD prescription was dwell volume -1.5 liters, dwell time-30 mins for 24 to 36 hrs. The maximum prescribed cycles were 36 cycles per patient.
Baseline characteristics such as age, sex, comorbidities, hemodynamic status, and renal function test were collected from records and analyzed
Results:
The total no. of patients studied was 101(n=101). Mean age -51.63 ±15.5yrs (Males 67%). Patients who were initiated on acute PD in the AKI category were 29%(n=29); acute on CKD 28% (n=28); CKD5 43%(n=44). Hemodynamically unstable patients were 45 %(n=45). Uremic encephalopathy was the most common indication for PD in 42%(n=43) followed by acute pulmonary edema at 35.6%(n=36); metabolic acidosis at 10.8% (n=11) and anuria at 10%(n=10).In the AKI category, uremic encephalopathy 55%(n=16) was the most common indication for PD followed by anuria 31%(n=9); and metabolic acidosis 14%(n=4). Patients converted from PD TO HD were 31.6 %(n=32). Patients who became dialysis independent after a single session of acute PD were 17.8 %(n=18). Complete renal recovery occurred in the AKI group was 9.9%(n=10). Sepsis (59.6%;n=34) was the most common acute component in this case series followed by Tropical AKI (19%;n=11). PD-related complications occurred in 11.8% of patients(n=12). Among them, peri catheter leak (n=5) was the commonest followed by outflow failure(n=4). Overall mortality was 51%(n= 52). Among AKI group, mortality was 65.5%(n=19); acute on CKD 78.5 % (n= 22); CKD-5 22.4%(n=11). Mortality among hemodynamically unstable pts was 84% (n=38).
Conclusions:
Acute PD still remains a viable option of RRT in resource-limited settings with minimal complications. Hemodynamic status and multiorgan dysfunction play a major role in determining survival in acute PD patients
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.