Is peritoneal dialysis adequate for hypercatabolic acute renal failure in developing countries?
BACKGROUND
Peritoneal dialysis (PD) is a therapeutic option for acute renal failure (ARF) in developing countries, despite concerns about inadequacy. Shorter and more efficient tidal peritoneal dialysis (TPD) was compared with continuous equilibrating peritoneal dialysis (CEPD) therapy in ARF by using their adequacies as accepted standards and analyzing the solute reduction indices (SRI).


METHODS
A prospective, randomized crossover trial was performed in patients with mild to moderate hypercatabolic ARF who were assigned to CEPD and TPD therapy after an adequate washout period. Solute clearances (Kt/V, normalized creatinine clearances) were compared to NKF guidelines. Potassium and phosphate clearances, dextrose absorption, protein losses and costs were compared. Kt/V was compared to SRIdialysate, SRIKt/V.


RESULTS
Eighty-seven patients with ARF received 236 sessions of dialysis (118 in each treatment). TPD resulted in higher clearances of solutes than CEPD (creatinine and urea clearances in mL/min of 9.94 +/- 2.93, 6.74 +/- 1.63 and 19.85 +/- 1.95, 10.63+/- 2.62, respectively, P=0.001). TPD and CEPD normalized creatinine clearances (L/week/1.73 m2 BSA) and Kt/V values were 68.5 +/- 4.43, 58.85 +/- 2.57 and 2.43 +/- 0.87, 1.80 +/- 0.32, respectively. CEPD did not meet standards of adequacy. TPD resulted in greater potassium and phosphate clearances, less dextrose absorption and was less expensive. CEPD resulted in less protein loss. Kt/V corresponded to SRIdialysate 0.88 +/- 0.12 (P=0.076).


CONCLUSIONS
TPD produced higher solute clearances in less time with greater protein loss. CEPD just fell short to meet the dialysis adequacy standard. However, both TPD and CEPD are reasonable options for mild-moderate hypercatabolic ARF. Kt/V appropriately estimates solute removal in PD.
Chitalia
Vipul Chimanlal
VC
Division of Nephrology, Department of Medicine, Renal Laboratory, and Department of Dietetics, Seth G.S. Medical College & King Edward Memorial Hospital, University of Bombay, Mumbai, India. chitalia_v@yahoo.com
Almeida
Alan Fernandes
AF
Rai
Harinakshi
H
Bapat
Mansi
M
Chitalia
Kinnari Vipul
KV
Acharya
Vidya N
VN
Khanna
Ramesh
R
D058186:Acute Kidney Injury / Q000191:economics / Q000378:metabolism* / Q000628:therapy*; D000328:Adult; D003365:Costs and Cost Analysis; D018592:Cross-Over Studies; D003906:Developing Countries; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics*; D010538:Peritonitis / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome