Question 28

a)    List the advantages, contraindications, and potential complications, for the use of peritoneal dialysis (PD) for treatment of acute kidney injury (AKI) in the critically ill patient.    (80% marks)

b)    Outline the essential components of an acute PD prescription.    (20% marks)

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College answer

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  • Anticoagulation is not required
  • There is no immunogenic extracorporeal circuit
  • Haemodynamically better tolerated
  • Markedly decreased risk of dialysis disequilibrium syndrome
  • Does not require an expensive machine
  • Less nursing staff workload, as compared to CVVHDF
  • The patient may remain ambulant while intermittent PD is in progress
  • An unexpected source of glucose, for patients who need extra calories


  • Recent abdominal surgery
  • Acute severe pulmonary oedema or immediately life-threatening electrolyte derangement (eg. sever hyperkalemia)
  • Peritoneal adhesions or previous major abdominal surgery is only a relative contraindication, as it only makes laparoscopic catheter placement more challenging.
  • Patients who have diaphragmatic pleuroperitoneal connections (i.e. all the fluid will end up in the chest)
  • Patients in severe respiratory failure, who are at the border of requiring mechanical ventilation
  • Patients with intraabdominal sepsis or abdominal wall infections
  • Pregnant patients
  • Patients with poorly controlled diabetes
  • Shocked patients will have poorer peritoneal blood flow, and therefore lower efficiency of dialysis via the peritoneal membrane.


  • Peritonitis
  • Perforation of a viscus (emergency catheter placement)
  • Respiratory failure
  • Pleural effusion
  • Protein loss- up to 20g/day, or perhaps even higher if you have peritonitis
  • Hypernatremia due to water removal
  • Gastro-oesophageal reflux
  • Poor solute clearance
  • Catheter insertion site leakage
  • Abdominal hernias


Essential components of an acute PD prescription:

  • Dialysate concentration: usually 1.5-2.5% dextrose,  up to 4.25% to increase fluid removal
  • Exchange volume is the administered volume, and this is usually 2L (30-40ml/kg)
  • Inflow time is the time it takes to fill the peritoneal cavity, and this is usually 15-30 minutes (200ml/min). 
  • Dwell time is the period for which the exchange volume remains in the peritoneal cavity (30 -90 minutes)
  • Outflow time depends on the volume and the catheter; it is a gravity-dependent drainage of dialysate fluid.
  • Number of exchanges: 4-6 exchanges per day for a stable patient, more if rapid solute control is required


Ash, Stephen R., and Carlo Crepaldi. "Indications, Contraindications, and Complications of Peritoneal Dialysis in Acute Renal Failure." Critical Care Nephrology. Elsevier, 2019. 1088-1095.

Flessner, Michael F. "The peritoneal dialysis system: Importance of each component." Peritoneal Dialysis International 17.2_suppl (1997): 91-97.

Ponce Gabriel, Daniela, et al. "Peritoneal dialysis in acute renal failure." Renal failure 28.6 (2006): 451-456.