Ponce Daniela, Balbi Andre, Cullis Brett
Department of Medicine, Botucatu School of Medicine, Sao Paulo, Brazil.
Renal Unit, Greys Hospital, Pietermaritzburg, South Africa.
Semin Nephrol. 2017 Jan;37(1):103-112. doi: 10.1016/j.semnephrol.2016.10.011.
Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to hemodialysis not only in the chronic setting, but also in the acute setting. It previously was widely accepted for acute kidney injury (AKI) treatment, but its practice decreased in favor of other types of extracorporeal therapies. The interest in PD to manage AKI patients has been reignited and PD now frequently is used in developing countries because of its lower cost and minimal infrastructural requirements. Studies from these countries have shown that, with careful thought and planning, critically ill patients can be treated successfully using PD. Some of the classic limitations of PD use in AKI, such as a high chance of infectious and mechanical complications and poor metabolic control, have been overcome with the use of cyclers, flexible catheters, and a high volume of dialysis fluid. However, in developing countries the infrastructure for quality research often is lacking and the result has been limited evidence on standardized treatment regimens such as indications, dosing, and technical failure and mortality. The recent publication of the International Society for Peritoneal Dialysis guidelines for PD in AKI have tried to address these issues and provide an evidence-based standard by which to initiate therapy. In this article, advances in technical aspects and the advantages and limitations of PD are discussed, and recent literature on clinical experience with PD for the treatment of AKI patients is reviewed.
腹膜透析（PD）不仅在慢性情况下，而且在急性情况下，都可能是一种可行、安全且可作为血液透析补充的替代方法。它曾被广泛用于急性肾损伤（AKI）的治疗，但后来其应用减少，转而青睐其他类型的体外治疗方法。现在，由于成本较低且对基础设施要求 minimal，发展中国家对使用PD治疗AKI患者的兴趣再度燃起，且PD目前在这些国家经常被使用。来自这些国家的研究表明，经过仔细考虑和规划，危重症患者可以通过PD成功治疗。使用循环器、柔性导管和大量透析液克服了PD在AKI应用中的一些经典局限性，如感染和机械并发症的高风险以及代谢控制不佳等问题。然而，在发展中国家，往往缺乏开展高质量研究的基础设施，结果是关于标准化治疗方案（如适应症、剂量、技术失败和死亡率）的证据有限。国际腹膜透析学会关于AKI中PD的指南最近发表，试图解决这些问题，并提供一个基于证据的启动治疗的标准。本文讨论了技术方面的进展以及PD的优缺点，并回顾了关于PD治疗AKI患者临床经验的最新文献。
