title: High-volume peritoneal dialysis in acute kidney injury: indications and limitations.
abstract: OBJECTIVE
  Peritoneal dialysis is still used for AKI in developing countries despite concerns about its limitations. The objective of this study was to explore the role of high-volume peritoneal dialysis in AKI patients in relation to metabolic and fluid control, outcome, and risk factors associated with death.
  
  
  METHODS
  A prospective study was performed on 204 AKI patients who were assigned to high-volume peritoneal dialysis (prescribed Kt/V=0.60/session) by flexible catheter and cycler; 150 patients (80.2%) were included in the final analysis.
  
  
  RESULTS
  Mean age was 63.8±15.8 years, 70% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (54.7%). BUN and creatinine levels stabilized after four sessions at around 50 and 4 mg/dl, respectively. Fluid removal and nitrogen balance increased progressively and stabilized around 1200 ml and -1 g/d after four sessions, respectively. Weekly delivered Kt/V was 3.5±0.68. Regarding AKI outcome, 23% of patients presented renal function recovery, 6.6% of patients remained on dialysis after 30 days, and 57.3% of patients died. Age and sepsis were identified as risk factors for death. In urine output, increase of 1 g in nitrogen balance and increase of 500 ml in ultrafiltration after three sessions were identified as protective factors.
  
  
  CONCLUSIONS
  High-volume peritoneal dialysis is effective for a selected AKI patient group, allowing adequate metabolic and fluid control. Age, sepsis, and urine output as well as nitrogen balance and ultrafiltration after three high-volume peritoneal dialysis sessions were associated significantly with death.
authors.affiliation: Internal Medicine, Botucatu Medical School-UNESP, Sao Paulo State University, Sao Paulo, Brazil. dponce@fmb.unesp.br
authors.forename: Daniela
authors.initials: D
authors.lastname: Ponce
authors.forename: Marina Nogueira
authors.initials: MN
authors.lastname: Berbel
authors.forename: Cassiana
authors.initials: C
authors.lastname: Regina de Goes
authors.forename: Cibele Taís Puato
authors.initials: CT
authors.lastname: Almeida
authors.forename: André Luís
authors.initials: AL
authors.lastname: Balbi
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D001938:Brazil; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014554:Urination; D014882:Water-Electrolyte Balance
chemical_list: D015415:Biomarkers; D003404:Creatinine