scholarly journals Is Peritoneal Dialysis a Suitable Method of Renal Replacement Therapy in Acute Kidney Injury?

10.5772/64668 ◽  
2016 ◽  
Author(s):  
Damir Rebić ◽  
Vedad Herenda
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Suitable Method

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.

scholarly journals Acute Kidney Injury in Asia

2016 ◽  
Vol 2 (3) ◽  
pp. 95-102 ◽  
Author(s):  
Li Yang
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
North America ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Environmental Toxins ◽  
Asian Countries ◽  
Western Countries ◽  
Tropical Areas

Background: Acute kidney injury (AKI) is a common disorder and is associated with a high morbidity and mortality worldwide. The diversity of the climate and of the socioeconomic and developmental status in Asia has a great influence on the etiology and presentation of AKI in different regions. In view of the International Society of Nephrology's 0by25 initiative, more and more attention has been paid to AKI in Asian countries. Summary: In this review, we summarize the recent achievements with regard to the prevalence and clinical patterns of AKI in Asian countries. Epidemiological studies have revealed the huge medical and economic burden of AKI in Eastern Asian countries, whereas the true epidemiological picture of AKI in the tropical areas is still not well understood. In high-income Asian regions, the presentation of AKI resembles that in other developed countries in Europe and North America. In low-income regions and tropical areas, infections, environmental toxins, and obstetric complications remain the major culprits in most cases of AKI. Preventive opportunities are missed because of failure to recognize the risk factors and early signs of AKI. Patients often present late for treatment or are recognized late by physicians, which leads to more severe kidney injury, multiorgan involvement, and increased mortality. There is significant undertreatment of AKI in many regions, and medical resources for renal replacement therapy are not universally available. Key Messages: More efforts should be made to increase public awareness, establish preventive approaches in communities, educate health-care practitioner entities to achieve better recognition, and form specialist renal teams to improve the treatment of AKI. The choice of renal replacement therapy should fit patients' needs, and peritoneal dialysis can be practiced more frequently in the treatment of AKI patients. Facts from East and West: (1) More than 90% of the patients recruited in AKI studies using KDIGO-equivalent criteria originate from North America, Europe, or Oceania, although these regions represent less than a fifth of the global population. However, the pooled incidence of AKI in hospitalized patients reaches 20% globally with moderate variance between regions. (2) The lower incidence rates observed in Asian countries (except Japan) may be due to a poorer recognition rate, for instance because of less systematically performed serum creatinine tests. (3) AKI patients in South and Southeastern Asia are younger than in East Asia and Western countries and present with fewer comorbidities. (4) Asian countries (and to a certain extent Latin America) face specific challenges that lead to AKI: nephrotoxicity of traditional herbal and less strictly regulated nonprescription medicines, environmental toxins (snake, bee, and wasp venoms), and tropical infectious diseases (malaria and leptospirosis). A higher incidence and less efficient management of natural disasters (particularly earthquakes) are also causes of AKI that Western countries are less likely to encounter. (5) The incidence of obstetric AKI decreased globally together with an improvement in socioeconomic levels particularly in China and India in the last decades. However, antenatal care and abortion management must be improved to reduce AKI in women, particularly in rural areas. (6) Earlier nephrology referral and better access to peritoneal dialysis should improve the outcome of AKI patients.

scholarly journals Peritoneal Dialysis in Renal Replacement Therapy for Patients with Acute Kidney Injury

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Naheed Ansari
Keyword(s):  
Acute Kidney Injury ◽  
Developing Countries ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Renal Replacement Therapies ◽  
Continuous Renal Replacement Therapies ◽  
Trained Staff

Peritoneal dialysis (PD) was the first modality used for renal replacement therapy (RRT) of patients with acute kidney injury (AKI) because of its inherent advantages as compared to Hemodialysis. It provides the nephrologist with nonvascular alternative for renal replacement therapy. It is an inexpensive modality in developing countries and does not require highly trained staff or a complex apparatus. Systemic anticoagulation is not needed, and it can be easily initiated. It can be used as continuous or intermittent procedure and, due to slow fluid and solute removal, helps maintain hemodynamic stability especially in patients admitted to the intensive care unit. PD has been successfully used in AKI involving patients with hemodynamic instability, those at risk of bleeding, and infants and children with AKI or circulatory failure. Newer continuous renal replacement therapies (CRRTs) are being increasingly used in renal replacement therapy of AKI with less use of PD. Results of studies comparing newer modalities of CRRT versus acute peritoneal dialysis have been conflicting. PD is the modality of choice in renal replacement therapy in pediatric patients and in patients with AKI in developing countries.

Renal replacement therapy in the patient with acute kidney injury

2018 ◽  
Author(s):  
Jang Won Seo ◽  
Ravindra L. Mehta
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Optimal Dose ◽  
Intermittent Haemodialysis ◽  
Management Of Complications ◽  
Low Efficiency ◽  
Timing Of Initiation

Several techniques for renal replacement therapy are now utilized to manage patients with acute kidney injury including intermittent haemodialysis, continuous renal replacement therapy, sustained low-efficiency dialysis, and peritoneal dialysis. This chapter provides an update on contemporary issues including advances in dialysis technology and its effects on the application of dialysis in acute kidney injury. The timing of initiation, modality choice, optimal dose, and management of complications in dialysis are some of the areas where there is controversy.

Acute kidney injury in children

2015 ◽  
Author(s):  
Alexander Fichtner ◽  
Franz Schaefer
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Pharmacological Intervention ◽  
Preterm Neonates ◽  
Technological Advances ◽  
Late Start

In the past few decades, the overall incidence of acute kidney injury (AKI) in paediatric patients has increased and the aetiological spectrum has shifted from infection-related and intrinsic renal causes towards secondary forms of AKI related to exposure to nephrotoxic drugs and complex surgical, oncological, and intensive care manoeuvres. In addition, neonatal kidney impairment and haemolytic uraemic syndrome continue to be important specific paediatric causes of AKI raising unique challenges regarding prevention, diagnosis, and treatment. The search for new biomarkers is a current focus of research in paediatric as in adult AKI research.Pharmacological intervention studies to prevent or attenuate AKI have provided positive evidence only for the prophylactic use of theophylline in severely depressed neonates, whereas dopamine and loop diuretics did not demonstrate any efficacy. Preliminary findings support a dose-dependent renoprotective action of fenoldopam in infants undergoing cardiac surgery.Critical issues in the management of AKI in children include fluid handling, maintenance of adequate nutrition, and the choice of renal replacement therapy modality. Observational studies have suggested an adverse impact of fluid overload and late start of renal replacement therapy, and a randomized clinical trial revealed detrimental effects of aggressive fluid bolus therapy in volume-depleted children.Technological advances have made it possible to apply continuous replacement therapies in children of all ages, including preterm neonates, using appropriately sized catheters, filters, tubing, and flow settings adapted to paediatric needs. However, the majority of children with AKI worldwide are still treated with peritoneal dialysis, and comparative studies demonstrating superiority of extracorporeal techniques over peritoneal dialysis are lacking.The outcomes of paediatric AKI are comparable to adult patients. In critically ill children, mortality risk increases with each stage of AKI; mortality rates typically range between 15% and 30% for all AKI stages and 30% to 60% in children requiring renal replacement therapy. Chronic kidney disease develops in approximately 10% of children surviving AKI.

scholarly journals The Clinical Utility of Kinetic Glomerular Filtration Rate in the Assessment of Renal Function and Prediction of Outcomes Among Critically Ill Patients With Acute Kidney Injury: A Single-Center Retrospective Cohort Study

2021 ◽  
Vol 5 (1) ◽  
pp. 611-620
Author(s):  
Shari Ann Atanacio ◽  
Maria Rachel Uy
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Urine Output ◽  
Filtration Rate ◽  
Kidney Injury

Objective: To determine the discriminatory ability of kinetic glomerular filtration rate (kGFR) to detect acute kidney injury (AKI) when compared with established GFR equations and criteria and relating it to mortality, renal replacement therapy initiation and renal recovery. Methods: This was a retrospective analysis using data from chart review of 109 intensive care unit (ICU) patients at the University of Santo Tomas Hospital (USTH). The renal function estimates using Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi), modification of diet in renal disease (MDRD), Kidney Disease Improving Global Outcomes Acute Kidney Injury (KDIGO AKI), as well as kinetic GFR equations were compared and correlated with renal and cardiovascular outcomes. Results: The renal function assessed by kGFR, CKD-Epi, MDRD and KDIGO staging based on serum creatinine (SCr) showed no significant association with mortality outcomes. However, AKI diagnosed based on urine output (UO), and combined SCr and urine output (KDIGO) showed association with all-cause mortality. The UO detected severe stages of AKI while SCr (based on KDIGO) better identified the earlier stages of AKI. The criteria for KDIGO AKI when combined also shows mortality prediction since it joins together the effects of SCr and UO. There was a remarkable 3.5 times increase  in hemodialysis initiation (p=0.0001) and 12.89 times increase in peritoneal dialysis initiation (p=0.01) for every stage increase in the KDIGO classification. kGFR, CKD-Epi and MDRD have 5%, 6%, and 6% decrease, respectively in the odds of initiating hemodialysis. There was however, no association for peritoneal dialysis. Conclusion: kGFR was the least able in detecting AKI and KDIGO AKI criteria remains to be the standard in identifying AKI in the critical care setting. Increase in SCr was a sensitive tool in diagnosing AKI due to its ability to detect AKI based on a small increase in SCr regardless of the baseline renal function. Decreasing UO, however, is the prognosticating variable in KDIGO AKI criteria, in that it portends higher probability of initiation of renal replacement therapy (RRT) and ultimately higher mortality when present.

scholarly journals Manual Acute PD with Rigid Catheters: A Relook

2015 ◽  
Vol 8 (1) ◽  
pp. 41-44
Author(s):  
Mayoor V Prabhu ◽  
Subhramanyam S.V ◽  
Sinoj Antony ◽  
Nayak K.S
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Special Reference ◽  
Replacement Therapy ◽  
Lower Cost ◽  
Developing World ◽  
Kidney Injury ◽  
Fluid Removal ◽  
Attractive Option

Peritoneal Dialysis (PD) has been an underutilized modality in the treatment of Acute Kidney Injury (AKI). Concerns regarding clearance, fluid removal, infection, complications of therapy, and the hypercatabolic state of AKI has led to PD falling into disrepute. Recent studies have challenged this notion of ineffectiveness. The lower cost, and simplicity of the procedure makes it a particularly attractive option for the developing world which may lack even basic HD facilities, and patients continue to die for want of Renal Replacement Therapy (RRT). We present a review of the available literature about PD in the AKI setting with special reference to the developing world, including the procedure, costs, and effectiveness of the treatment. We also describe the procedure in detail to help ‘hand hold’ physicians interested in performing this lifesaving procedure.

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