| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Part 3: Clinical Experiences |
Department of Internal Medicine, University Hospital, Botucatu School of Medicine, São Paulo State University, São Paulo, Brazil
Correspondence to: D.P. Gabriel, Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, UNESP, Rubião Júnior, P.O. Box 584, CEP 18618-970, São Paulo, Brazil. dponcegabriel{at}uol.com.br
Background: In some parts of the world, peritoneal
dialysis is widely used for renal replacement therapy (RRT) in acute kidney
injury (AKI), despite concerns about its inadequacy. It has been replaced in
recent years by hemodialysis and, most recently, by continuous venovenous
therapies. We performed a prospective study to determine the effect of
continuous peritoneal dialysis (CPD), as compared with daily hemodialysis
(dHD), on survival among patients with AKI. Methods: A total of 120 patients with acute tubular
necrosis (ATN) were assigned to receive CPD or dHD in a tertiary-care
university hospital. The primary endpoint was hospital survival rate; renal
function recovery and metabolic, acid–base, and fluid controls were
secondary endpoints. Results: Of the 120 patients, 60 were treated with CPD
(G1) and 60 with dHD (G2). The two groups were similar at the start of RRT
with respect to age (64.2 ± 19.8 years vs 62.5 ± 21.2 years),
sex (men: 72% vs 66%), sepsis (42% vs 47%), shock (61% vs 63%), severity of
AKI [Acute Tubular Necrosis Individual Severity Score (ATNISS): 0.68 ±
0.2 vs 0.66 ± 0.22; Acute Physiology and Chronic Health Evaluation
(APACHE) II: 26.9 ± 8.9 vs 24.1 ± 8.2], pre-dialysis blood urea
nitrogen [BUN (116.4 ± 33.6 mg/dL vs 112.6 ± 36.8 mg/dL)], and
creatinine (5.85 ± 1.9 mg/dL vs 5.95 ± 1.4 mg/dL). In G1, weekly
delivered Kt/V was 3.59 ± 0.61, and in G2, it was 4.76 ± 0.65
(p < 0.01). The two groups were similar in metabolic and
acid–base control (after 4 sessions, BUN < 55 mg/dL: 46 ± 18.7
mg/dL vs 52 ± 18.2 mg/dL; pH: 7.41 vs 7.38; bicarbonate: 22.8 ±
8.9 mEq/L vs 22.2 ± 7.1 mEq/L). Duration of therapy was longer in G2
(5.5 days vs 7.5 days; p = 0.02). Despite the delivery of different
dialysis methods and doses, the survival rate did not differ between the
groups (58% in G1 vs 52% in G2), and recovery of renal function was similar
(28% vs 26%). Conclusion: High doses of CPD provided appropriate
metabolic and pH control, with a rate of survival and recovery of renal
function similar to that seen with dHD. Therefore, CPD can be considered an
alternative to other forms of RRT in AKI.
KEY WORDS: Acute renal failure; daily hemodialysis.
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
 |
