Peritoneal dialysis for acute kidney injury

Area of Science:

• Nephrology
• Critical Care Medicine

Background:

• Peritoneal dialysis (PD) is a potential treatment for acute kidney injury (AKI).
• Its superiority over extracorporeal therapy (e.g., hemodialysis) remains unclear regarding survival and functional recovery.
• This review evaluates PD's benefits and harms in AKI patients compared to other therapies.

Purpose of the Study:

• To assess the benefits and harms of peritoneal dialysis (PD) for acute kidney injury (AKI).
• To compare PD with extracorporeal therapy and different PD modalities in AKI patients.

Main Methods:

• Systematic review of randomized controlled trials sourced from Cochrane Kidney and Transplant Register, CENTRAL, MEDLINE, EMBASE, ICTRP, and ClinicalTrials.gov.
• Included studies involved AKI patients randomized to PD or extracorporeal therapy.
• Data extraction and quality assessment by two authors; random-effects model for statistical analysis; GRADE for evidence certainty.

Main Results:

• Six studies (484 participants) were included; five compared PD with various extracorporeal therapies.
• PD showed little to no difference in all-cause mortality (moderate certainty) or kidney function recovery (moderate certainty) versus extracorporeal therapy.
• PD may slightly reduce fluid removal (low certainty) and offers uncertain benefits for Kt/V, acidosis correction, and dialysis duration, with potential advantages for extracorporeal therapy in fluid removal and dialysis efficiency.

Conclusions:

• Peritoneal dialysis (PD) likely offers little to no difference compared to extracorporeal therapy for treating acute kidney injury (AKI) based on current evidence.
• Extracorporeal therapy may be superior for fluid removal and dialysis efficiency (Kt/V).
• Further research is needed due to high heterogeneity and low-certainty evidence for several outcomes.