Peritoneal dialysis in the critically ill

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.