[Peritoneal dialysis in patients with acute renal failure].

The management of patients with acute renal failure (ARF) is very complex and requires meticulous attention to fluid, acid-base and electrolyte balance as well as the removal of uraemic toxins. Peritoneal dialysis (PD) is an important option for treatment of selected patients with ARF, particularly those who are haemodynamically compromised or have coagulation abnormalities. Due to continuous therapy, its efficacy is the same as on haemodialysis, even better. Advantages of PD in ARF therapy: it is widely available and easy to perform; insertion of PD catheter is relatively easy, PD does not require special staff or expensive equipment, arterial or venous puncture and anticoagulation; dosing is easy; there is no interaction between blood and dialyser and there are no episodes of hypotension like in haemodialysis (HD) patients; acid-base and electrolyte imbalance may be easily and gradually corrected, large amounts of fluid can be removed in haemodynamically unstable patients, which allows parenteral nutrition. PD is less efficient than HD in therapy of acute complications (pulmonary oedema, intoxication or hyperkaliaemia) and is not the therapy of choice in patients with extreme catabolism who require daily HD or some other kind of continuous renal replacement therapy. The absolute indication for acute PD is the need for dialysis and inability to perform any other renal replacement technique. Relative indications for acute PD in adults are the following: haemodynamically unstable patients, the presence of bleeding or haemorrhagic conditions, difficulty in obtaining vascular approach, removal of high molecular weight toxins, heart failure refractory to medical treatment. Absolute contraindications for PD are the following: recent abdominal or cardiothoracic surgery, diaphragmatic peritoneal-pleural connections, faecal or fungal peritonitis. Other contraindications are relative. Accordingly, acute PD is the mode of therapy in some specific patients with ABI, especially patients in intensive care units. Survival of ARF patients is similar in PD and HD patients, so acute PD is very important in their therapy.