Peritoneal dialysis in adult patients without end-stage renal disease.

End-stage renal disease remains the primary indication for the use of peritoneal dialysis. The therapy, however, has been used for the treatment of various other clinical conditions. Evidence has accumulated to support the use of peritoneal dialysis to maintain euvolemia, to improve functional status, and to reduce hospitalizations in patients with intractable chronic congestive heart failure. The use of peritoneal dialysis as a modality for core rewarming in patients with severe hypothermia has been established; in selected circumstances, it is probably the therapy of choice. The field of oncology has borrowed heavily from the technique of peritoneal dialysis for administering intraperitoneal chemotherapy; even though the therapy remains largely experimental today, it has great future potential. While efficacious in the treatment of acute, diuretic-resistant volume overload in patients with congestive heart failure and in patients with severe, disabling psoriasis, the introduction of alternative methods of management have rendered the use of peritoneal dialysis obsolete. Finally, the role of peritoneal lavage in the management of patients with pancreatitis remains controversial and is no longer routinely used.