Early introduction of peritoneal dialysis may improve survival in severe sepsis

Acute renal failure is a serious complication of sepsis and is associated with a very high mortality. Recent evidence suggests that proinflammatory cytokines (interleukins 1 and 6 and tumor necrosis factor alpha) released into the circulation in response to sepsis can be removed from the blood via hemofiltration and appear in the dialysate in times of peritoneal dialysis as well.

An infant who developed acute renal failure in full-blown sepsis is presented. Peritoneal dialysis was initiated on the fourth day after admission. Changes in clinical and laboratory parameters were monitored.

Urine output (1.13 mL/kg per hour) began to improve on the sixth day after admission (second day after the introduction of peritoneal dialysis); normalization of serum creatinine level was achieved on the 30th day after admission. Parallel with the serum creatinine level (255 micromol/L on day 5 after admission vs 208 micromol/L by day 9 after admission, fifth day of PD), serum procalcitonin, C-reactive protein, and lactate dehydrogenase levels decreased dramatically (procalcitonin >500 vs 261 microg/L; C-reactive protein, 203 vs 25.9 mg/L; and lactate dehydrogenase, 3092 vs 1744 U/L on days 5 and 9 after admission, respectively).

Considering that there are no guidelines defined for the management of acute renal failure with accompanying sepsis in children, authors point out that peritoneal dialysis is an easy-to-perform and effective renal replacement modality in low body weight, critically ill patients. Early initiation of peritoneal dialysis does not only improve fluid and electrolyte imbalance but also may significantly reduce the destructive effect of systemic cytokine storm in sepsis and contribute to a more favorable outcome, even in cases of critical cardiovascular and hemostaseological status.