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Is peritoneal dialysis adequate for hypercatabolic acute renal failure in developing countries?
Vipul Chimanlal Chitalia1, Alan Fernandes Almeida, Harinakshi Rai
1Division of Nephrology, Department of Medicine, Renal Laboratory, and Department of Dietetics, Seth G.S. Medical College & King Edward Memorial Hospital, University of Bombay, Mumbai, India. chitalia_v@yahoo.com
Kidney International
|February 19, 2002
Summary
Tidal peritoneal dialysis (TPD) offers superior solute clearance for acute renal failure (ARF) compared to continuous equilibrating peritoneal dialysis (CEPD). Both methods are viable for ARF management, with TPD being more efficient and cost-effective.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Dialysis Techniques
Background:
- Peritoneal dialysis (PD) is a crucial treatment for acute renal failure (ARF), especially in developing nations.
- Concerns regarding PD inadequacy necessitate the evaluation of alternative methods like tidal peritoneal dialysis (TPD).
- Comparing TPD with continuous equilibrating peritoneal dialysis (CEPD) is vital for optimizing ARF management.
Purpose of the Study:
- To compare the efficacy of TPD and CEPD in treating mild to moderate hypercatabolic ARF.
- To assess dialysis adequacy using solute reduction indices (SRI) and established guidelines.
- To analyze solute clearances, electrolyte balance, nutrient absorption, protein loss, and cost-effectiveness of both PD methods.
Main Methods:
- A prospective, randomized crossover trial involving patients with mild to moderate hypercatabolic ARF.
- Patients underwent both CEPD and TPD therapies after a washout period.
- Key metrics included solute clearances (Kt/V, creatinine), electrolyte removal, dextrose absorption, protein loss, and cost.
Main Results:
- TPD demonstrated significantly higher creatinine and urea clearances compared to CEPD.
- TPD achieved higher normalized creatinine clearances and Kt/V values, meeting adequacy standards.
- CEPD fell short of the dialysis adequacy standard, though TPD showed greater protein loss and lower cost.
Conclusions:
- TPD is a more efficient method for solute removal in ARF, requiring less time.
- Both TPD and CEPD are considered reasonable treatment options for mild-moderate hypercatabolic ARF.
- Kt/V serves as an appropriate measure for estimating solute removal in peritoneal dialysis.