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Peritoneal Dialysis Therapy in the Acute Kidney Injury Setting: Back to the Future (pp. 193-220) $100.00
Authors:  (José Carolino Divino-Filho)
Abstract:
The scope of this chapter is not about AKI per se, but on the practice of peritoneal
dialysis (PD) as a dialysis therapy option for acute kidney injury (AKI). As a matter of a
fact, PD was the first dialysis mode applied for the treatment of kidney injury. The first PD
trial was carried out by Ganter in a patient with ureter obstruction due to a uterus carcinoma
in 1923.
Unfortunately, the experience and knowledge acquired and reported in the application
of PD in the AKI setting during the 50s, 60s, 70s and early 80s gradually vanished during
the late 80s, 90sand early 2000s, leaving a considerable gap of knowledge and experience
for some generations of nephrologists, which reverberated in other specialties. It is not
uncommon to discuss renal replacement therapy (RRT) for AKI with intensive care
colleagues and observe an attitude of disbelief and even of denial when mentioning PD as
an alternative. However, this is based on very scarce knowledge and no experience with
the therapy. The aim of this chapter is to highlight the important and positive role that PD
had in the treatment of AKI in the early years of dialysis up to the early 80s and to confirm
the re-emergence of PD for AKI in the last 12 years. In the “dark ages” of PD for AKI (late
80s until 2005), not only HD technology did develop considerably and its wide-spread
utilization increased exponentially, outpacing PD, but also the creation of continuous renal
replacement therapies (CRRT) concept and practice conquered ICUs throughout the
developed world. Moreover, during this period, PD-believers were focused on applying the
PD technology development to the expansion of PD as a chronic therapy (CAPD and APD)
for patients with end-stage renal diseaseThere had been negative publications about the use
of PD in AKI when compared to HD techniques (for example, continuous venous-venous
hemofiltration), which complicated things during this period. It is important to note that
mortality in AKI has not changed from early days to the present, regardless of the dialysis
modality prescribed. The turning point for going back to the future in the PD utilization for
AKI was the 2007 publication by a group of nephrologists from Botucatu, a university city
in Brazil, interested and experienced in PD. They had a well laid-off plan for this trailblazer
PD expedition, which they have exercised brilliantly. Their series of publications have
given solid evidence that PD can be considered as an alternative form of RRT in AKI, and
new evidence is being gathered from other corners of the world during the last years.
Current published studies do not support significant difference in outcomes between
PD and the other dialysis alternatives (CRRT and intermittent HD). This chapter hopes to
provide information not only supporting PD as an alternative to AKI therapy, but also as
an option among many other therapies that physicians treating AKI patients may have in
their arsenal of therapies, personalizing the treatment to each individual patient’s
conditions and needs. After reading this chapter, one may realize that we are back to the
future with the use of PD in the AKI setting. 


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Peritoneal Dialysis Therapy in the Acute Kidney Injury Setting: Back to the Future (pp. 193-220)