Role of Acute Intermittent Peritoneal Dialysis for the treatment of Acute Kidney Injury.

AIMS OF THE STUDY : 1. To identify the patient population who would be most benefited with peritoneal dialysis in AKI . 2. To analyse the factors affecting the outcome of patients with acute renal failure undergoing peritoneal dialysis . MATERIALS AND METHODS : SETTING : The study – “ Peritoneal dialysis in patients with acute kidney injury “ was carried out in the Department of Nephrology , Madras medical college and Govt. General Hospital, Chennai . PERIOD OF STUDY : 1st March 2007 to 30th November 2008. DESIGN OF STUDY : Prospective study of consecutive patients with acute kidney injury who underwent peritoneal dialysis in Govt. General Hospital , Chennai . SAMPLE SIZE : 151 patients who underwent peritoneal dialysis for acute kidney injury were included in this study . Indications for initiation of PD included volume overload, hyperkalemia refractory to medical treatment, metabolic acidosis , symptomatic uremia (pericarditis, encephalopathy, bleeding dyscrasia, nausea, vomiting ). METHODS : All patients with acute kidney injury undergoing peritoneal dialysis were evaluated by complete medical history , systemic examination ,standardized blood tests and imaging studies and were recorded in a standardized sheet . Clinical history and records regarding the cause of renal failure , diabetic or hypertensive status and drugs the patient had taken were obtained . Clinical examination regarding the volume status , need for pressor agents , evidence of other organ failure – jaundice , encephalopathy , respiratory distress , need for ventillatory support were recorded . Appropriate investigations for cause of renal failure , evidence of other organ dysfunction , and radiologic investigations as required were done . CONCLUSION : 1. Peritoneal dialysis had been found to be an effective way of renal replacement therapy in patients with AKI due to diarrhoeal illness . 2. Patients with snake bite or sepsis as cause of AKI eventually required hemodialysis or expired due to their illness and hence intermittent HD or CRRT should be considered in these patients . 3. PD can be an effective way of RRT in patients with AKI who are relatively younger , do not have comorbid illness like DM , absence of pulmonary edema or hyperkalemia , absence of other organ dysfunction ( bilirubin > 5 mg /dl ,coma or respiratory failure ) and in absence of DIC