title: Extending the role of peritoneal dialysis: can we win hearts and minds?
abstract: BACKGROUND
  The ability of peritoneal dialysis (PD) to achieve low-molecular weight solute clearance and ultrafiltration at low haemodynamic cost makes it an attractive therapy in situations where more aggressive therapy may be undesirable due to sudden reductions in cerebral, coronary or renal blood flow.
  
  
  METHODS
  We undertook a review of the literature to examine the recent evidence for this in two specific examples: the removal of glutamate following acute stroke and ultrafiltration for the treatment of diuretic resistant heart failure.
  
  
  RESULTS
  In acute stroke, glutamate, when released into the extracellular tissues, causes neuronal cell death due to its excitotoxic properties. Experimental evidence from animal models indicates that its removal, including via PD, can reduce infarct size and restore functional brain tissue. PD is effective in removing glutamate in patients treated for renal failure. In heart failure, PD has a number of both theoretical and practical advantages for extending treatment, especially as an established home therapy. Several recent cohort studies describing its use in approaching 300 patients with diuretic resistance show consistent benefits in hospitalization and severity.
  
  
  CONCLUSIONS
  Both these applications require substantial further clinical evaluation before they can justify wider adoption but their potential to alleviate morbidity on a large and potentially highly cost-effective scale demands further study.
authors: Heath Services Research Unit, Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK Department of Nephrology, University Hospital of North Staffordshire, Stoke-on-Trent, UK.
authors: Simon
authors: S
authors: Davies
authors: Heath Services Research Unit, Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK.
authors: Frank
authors: F
authors: Lally
authors: Heath Services Research Unit, Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK.
authors: Duwarakan
authors: D
authors: Satchithananda
authors: Heath Services Research Unit, Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK.
authors: Umesh
authors: U
authors: Kadam
authors: Heath Services Research Unit, Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK.
authors: Christine
authors: C
authors: Roffe
mesh_terms: D000818:Animals; D001921:Brain / Q000378:metabolism; D005260:Female; D018698:Glutamic Acid / Q000378:metabolism; D006333:Heart Failure / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D008297:Male; D009498:Neurotoxins / Q000378:metabolism; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000009:adverse effects; D051437:Renal Insufficiency / Q000209:etiology; D020521:Stroke / Q000378:metabolism / Q000628:therapy*; D014462:Ultrafiltration
chemical_list: D009498:Neurotoxins; D018698:Glutamic Acid
keywords: excitotoxicity; glutamate; heart failure; stroke; ultrafiltration