Peritoneal dialysis in patients with acute renal failure

Of the two main renal replacement therapies, peritoneal dialysis (PD) was the modality first used for the treatment of patients with acute renal failure (ARF) because of its inherent advantages. Highly trained personnel, expensive and complex apparatus, and systemic anticoagulation were not needed, and so the procedure could be simply and quickly initiated. Further, because of the gradual removal of fluid and solutes, PD results in better hemodynamic stability. Manually or cycler-assisted ("automated") PD has been successfully used in many ARF patients, especially those at risk of bleeding or with hemodynamic instability, and in infants and children with ARF or circulatory failure. Recently, technological developments in hemodialysis techniques (bicarbonate dialysis, hemofiltration, hemodiafiltration) and the continuous renal replacement therapies (CRRTs), have limited the indications for PD in critically ill patients with ARF. In addition, better knowledge about the connection between early and adequate dialysis dose and improved outcomes has led to a tendency to increase the dialysis dose given to ARF patients, furthering the development of newer techniques. Although PD has been considered less effective than hemodialysis and CRRTs are in patients with severe acute illness (pulmonary edema, poisoning, extreme catabolysis) and ARF, PD remains an effective therapy that is easily and simply instituted, especially for infants and children with ARF, both within and outside of intensive care settings.