Peritoneal dialysis: what the intensive care physician needs to know

Abstract

Peritoneal dialysis (PD) is an efficient kidney replacement therapy (KRT) that remains underused as a treatment of acute kidney injury (AKI) in intensive care, despite its many advantages such as the avoidance of difficulties in creatingvascular access, and hemodynamic instability during hemodialysis (HD), at lower costs than HD. The Sars-Cov2pandemic has highlighted the usefulness of this KRT, in a context of international shortage of healthcare staff and resources. The peritoneal membrane acts as an endogenous dialyzing membrane, solutes diffuse from the patient’s blood into the dialysate that is infused in the abdominal cavity, and excess body fluid s removed by osmosis. PD prescription must indicate the type of PD fluid, the dwell and total volume, as well as the PD modality. Several complications related to PD, infectious and non-infectious, can lead to technique failure if inadequately taken care of. In this update, we will describe the physiological principles of PD, the place of PD in the treatment of AKI, PD prescription, the impact of PD on mechanical ventilation as well as the management of PD related complications.