Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Saudi J Kidney Dis Transpl. 2020 Mar-Apr;31(2):423-430. doi: 10.4103/1319-2442.284017.
There are only a few reports on the role of peritoneal dialysis (PD) in critically ill patients requiring continuous renal replacement therapies (RRT). This study aimed to determine the efficacy and outcome of intermittent PD in acute kidney injury (AKI) patients in intensive care unit setting and to assess the procedure-related complications. This was a prospective, observational study conducted from March 1, 2015, to February 29, 2016, which included patients of either sex, aged ≥18 years, diagnosed with AKI, and undergoing RRT with intermittent PD sessions with more than 48 h of hospital stay. Patients were later shifted to sustained low- efficiency dialysis or hemodialysis, when they became hemodynamically stable. Hence, the patients who received at least 48 h of PD were included in the study. A total of 75 patients were enrolled. Overall, the mean age was 55.75 years, and around 64% were men. The most common indication to start PD was metabolic acidosis, and the most common cause of AKI was sepsis. A total of 21 patients survived, and the mortality rate was 72%. The average peritoneal urea clearance and creatinine clearance were 14.81 mL/min and 12.59 mL/min, respectively. Of the 66 patients on inotropes, 28 patients were tapered from inotropic support. Thirty-nine patients had hyperkalemia, and 27 patients had correction within 1 day of the start of PD. Forty-seven patients had correction of acidosis, and 33 of these achieved pH ≥7.25 within one day of PD. The most common complication that occurred was peri-catheter leaks followed by peritonitis. Acute PD can be an effective, simple, and safe bridge RRT in hemodynamically unstable patients until the achievement of hemodynamic stability to shift them to other modalities of RRT.
目前仅有少数研究报告探讨了连续性肾脏替代治疗（CRRT）中腹膜透析（PD）的作用。本研究旨在确定 ICU 中急性肾损伤（AKI）患者接受间歇性 PD 的疗效和预后，并评估与操作相关的并发症。这是一项前瞻性观察研究，于 2015 年 3 月 1 日至 2016 年 2 月 29 日进行，纳入年龄≥18 岁、诊断为 AKI、接受至少 48 小时 PD 治疗且住院时间超过 48 小时的患者。当患者血流动力学稳定时，将其转为持续低效透析或血液透析。因此，至少接受 48 小时 PD 治疗的患者被纳入研究。共纳入 75 例患者，平均年龄为 55.75 岁，约 64%为男性。开始 PD 的最常见指征是代谢性酸中毒，AKI 的最常见原因是感染。共有 21 例患者存活，死亡率为 72%。平均腹膜尿素清除率和肌酐清除率分别为 14.81mL/min 和 12.59mL/min。在使用正性肌力药物的 66 例患者中，28 例患者逐渐减少了正性肌力药物的使用。39 例患者出现高钾血症，27 例患者在 PD 开始后 1 天内得到纠正。47 例患者酸中毒得到纠正，其中 33 例在 PD 开始后 1 天内 pH 值≥7.25。最常见的并发症是导管周围渗漏，其次是腹膜炎。急性 PD 可以作为血流动力学不稳定患者有效的、简单的、安全的肾脏替代治疗桥接方法，直到患者血流动力学稳定，再将其转为其他肾脏替代治疗方式。
