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Peritoneal dialysis is a therapeutic strategy in patients with acute kidney injury (AKI) that may have advantages over other techniques regarding the safety and use of health resources. However, it has not been widely studied. This study aims to describe the clinical and safety outcomes of urgent-start peritoneal dialysis (within two weeks of catheter placement) with low doses of dialysate in patients with AKI in a resource-limited setting in Bolivia.
We conducted a retrospective observational study in a single centre, which included adults with AKI who received urgent-start peritoneal dialysis with low doses of dialysate, with at least 14 days of follow-up. Patients requiring haemodialysis were excluded. Through medical records review, clinical variables regarding the basal disease status, prescription characteristics of peritoneal dialysis, changes in electrolytes and renal function test, and safety outcomes were recorded.
A total of 39 patients were included, with a mean age of 64.4 years (SD 14.2). 61.5% were men. The majority had an ischemic AKI (59%), a KDIGO classification G5 (71.8%), and a low mortality risk according to SOFA (64.1%). Table 1 describes the basal characteristics of the population. Regarding the intervention, the insertion of the Tenckhoff catheter was performed by the general surgery department with a mini-laparotomy approach in all of the patients. The PD was performed with 18 liters of dialysate for a daily KTV of 0.33 and 2.31 weekly. The formula used to calculate KTV is as follows: K: Volume of dialysate/time x D/P ratio, T: therapy time, V: 0,6 x weight (Kg)
The concentrations of Dianeal® used were 1.5%, 2.5% and 4.25%, according to the clinical criteria of the nephrologist. The mean of the number of PD sessions during hospitalization was 6.8 (SD 6.9), with a mean duration of 15 hours (SD 4.8) per session. The mean fill volume per cycle was 2073.2 ml (SD 370.8), and the ultrafiltrate volume per session was 1416.9 ml (SD 1031.5). Concerning clinical results, we observed improved hydration status, edema, and diuresis. We also found an improvement in electrolytes and renal function (Figure 1). The average hospital stay was 10 (SD 9.6), ranging between 2 and 60 days. The most frequent complications during the study period were hydroelectrolyte alterations (92.3%), mainly hypokalemia in 54.8% of the cases. The most frequent mechanical complications were leaks, which occurred in 10.3% of the cases. Two cases of peritonitis were reported throughout the study.
The effectiveness and safety of peritoneal dialysis for initiating acute kidney replacement therapy have been underestimated compared to haemodialysis. Urgent-start PD with low doses of dialysate effectively achieves metabolic, acid-base and hydroelectrolytic control in 48 to 72 hours with minimal complications. Thus, urgent-start PD with low doses of dialysate is a valuable option with favourable clinical outcomes and low complication rates in patients with acute kidney injury in limited resource settings.