Indications, contraindications and complications of peritoneal dialysis in the critically ill

1998 ◽  
pp. 1373-1381 ◽  
Author(s):  
Sharad Goel ◽  
Rajiv Saran ◽  
Karl D. Nolph
Keyword(s):  
Peritoneal Dialysis ◽  
Critically Ill

Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

2020 ◽  
pp. 089686082097589
Author(s):  
Pallavi Choudhary ◽  
Virendra Kumar ◽  
Abhijeet Saha ◽  
Archana Thakur
Keyword(s):  
Mechanical Ventilation ◽  
Peritoneal Dialysis ◽  
Renal Impairment ◽  
Critically Ill ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Renal Outcome ◽  
Severe Dengue ◽  
Critically Ill Children

Background: Peritoneal dialysis (PD) is easily available and simple lifesaving procedure in children with renal impairment. There is paucity of reports on efficacy of PD in critically ill children in presence of shock and those requiring mechanical ventilation. Methods: In this prospective observational study, efficacy and outcome of PD were evaluated in 50 critically ill children aged 1 month to 14 years admitted in pediatric intensive care unit of a tertiary care teaching hospital in India. Results: Indication of PD was acute kidney injury (AKI) in 66% of patients followed by chronic kidney disease with acute deterioration due to infectious complications in 34%. Bacterial sepsis was the most common cause of AKI (22%), others being malaria (14%) and severe dengue (12%). At initiation of PD, 26% of patients were in shock and 46% were mechanically ventilated. PD was effective and improvement in pH, bicarbonate, and lactate started within hours, with consistent improvement in estimated glomerular filtration rate by 24 h, which continued till the end of procedure, including the subgroup of patients with shock and mechanical ventilation. Total complications were seen in 14% and of which peritonitis was present in 4.0% of patients. Mortality was seen in 14% (7/50) of patients. Shock at initiation of PD (odds ratio (OR), 5.03; 95% confidence interval (CI), 0.95–26.69; p < 0.04) and requirement of mechanical ventilation (OR, 9.17; 95% CI, 1.01–83.10; p < 0.02) were associated with mortality. Conclusions: Acute PD in critically ill children with renal impairment is a lifesaving procedure. Treatment of shock with resuscitative measures and respiratory failure with mechanical ventilation, along with PD, resulted in favorable renal outcome.

Peritoneal dialysis in the critically ill

2016 ◽  
Author(s):  
Jeffrey C. Sirota ◽  
Isaac Teitelbaum
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Metabolic Complications ◽  
Acute Setting ◽  
Attractive Option ◽  
Comparative Trials

Peritoneal dialysis, the first modality of renal replacement therapy used in patients with acute kidney injury, has now largely been supplanted by haemofiltration and haemodialysis. However, as acute kidney injury becomes more common and the need for renal replacement therapy increases, the technical advantages of peritoneal dialysis have made it an increasingly attractive option in acute settings, particularly in resource-deprived areas where haemodialysis is not available. Peritoneal modality can offer distinct advantages over haemodialytic techniques in patients with certain concomitant conditions. A variety of infectious, mechanical, pulmonary, and metabolic complications are possible with peritoneal dialysis, but the incidence of these is low in the acute setting. While not yet studied in robust comparative trials against the various haemodialytic modalities, there is some emerging evidence that peritoneal dialysis can provide adequate renal replacement therapy in acute settings, and acute peritoneal dialysis should be considered when haemodialysis is not available or its attendant complications are undesired.

Peritoneal Dialysis with Rigid Catheters in Children with Acute Kidney Injury: A Single-Centre Experience

2022 ◽  
Author(s):  
Manasi Garg ◽  
Lalitha A. V. ◽  
Anil Vasudevan
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Critically Ill ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Renal Outcome ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Major Life

AbstractPeritoneal dialysis (PD) is a simple and preferred modality of dialysis for children with acute kidney injury (AKI) in resource poor countries. The aim of the study is to evaluate the utility and safety of acute PD using rigid catheter in critically ill children admitted to pediatric intensive care unit (PICU) with emphasis on short-term patient and renal outcome and complications. In this retrospective study, outcome and complications of PD using rigid catheter were evaluated in 113 critically ill children admitted in PICU of a tertiary care hospital from 2014 to 2019. The most common causes for AKI were sepsis (39.8%), dengue infection (16.8%), and hemolytic uremic syndrome (13.2%). In 113 patients, 122 PD catheters were inserted, and the median duration of PD was 60 (IQR: 36–89) hours. At the initiation of PD, 64 (56.6%) patients were critically ill requiring mechanical ventilation and inotropes, 26 (23%) had disseminated intravascular coagulation, and 42 (37%) had multiorgan dysfunction syndrome. PD was effective and there was a significant improvement in urea and creatinine, and one-third patients (n = 38; 33.6%) had complete renal recovery at the end of PD. Total complications were seen in 67% children but majority of them were metabolic (39.8%). Total catheter related complications were seen in 21.2% and peritonitis was seen in 4.4%. Catheter removal due to complications was required in 8.8% children. Overall, among children on PD, 53.7% survived. Acute PD with rigid catheters can be performed bedside in absence of soft catheters and significant clearance can be obtained without major life-threatening complications.

scholarly journals Outcomes after Acute Peritoneal Dialysis for Critical Cardiorenal Syndrome Type 1

2021 ◽  
pp. 1-9
Author(s):  
Watanyu Parapiboon ◽  
Tanit Kingjun ◽  
Laddaporn Wongluechai ◽  
Waraporn Leawnoraset
Keyword(s):  
Peritoneal Dialysis ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Fluid Balance ◽  
Multivariable Analysis ◽  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Resource Limited ◽  
Limited Setting

<b><i>Introduction:</i></b> The aim of the study was to demonstrate the outcomes of peritoneal dialysis (PD) in critically ill cardiorenal syndrome type 1 (CRS1). <b><i>Methods:</i></b> A cohort of 147 patients with CRS1 who received PD from 2011 to 2019 in a referral hospital in Thailand was analyzed. The primary outcome was 30-day in-hospital mortality. Ultrafiltration and net fluid balance among survivors and nonsurvivors in the first 5 PD sessions were compared. <b><i>Results:</i></b> The 30-day mortality rate was 73.4%. Most patients were critically ill CRS1 (all patients had a respiratory failure of which 68% had cardiogenic shock). Blood urea nitrogen and creatinine at the commencement of PD were 60.1 and 4.05 mg/dL. In multivariable analysis, increasing age, unstable hemodynamics, and positive fluid balance in the first 5 PD sessions were associated with the risk of in-hospital mortality. The change of fluid balance per day during the first 5 dialysis days was significantly different among survivor and nonsurvivor groups (−353 vs. 175 mL per day, <i>p</i> = 0.01). <b><i>Conclusions:</i></b> PD is a viable dialysis option in CRS1, especially in a resource-limited setting. PD can save up to 27% of lives among patients with critically ill CRS1.

scholarly journals The Use of Acute Peritoneal Dialysis in Critically Ill Newborns

2016 ◽  
Vol 22 ◽  
pp. 1421-1426 ◽  
Author(s):  
Lokman Ustyol ◽  
Erdal Peker ◽  
Nihat Demir ◽  
Kemal Agengin ◽  
Oguz Tuncer
Keyword(s):  
Peritoneal Dialysis ◽  
Critically Ill
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