Journal of Regional Section of Serbian Medical Association in Zajecar

Year 2012     Vol 37     No 1
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      UDK 616.381-78

ISSN 0350-2899, 37(2012) br.1 p.34-41

Literature review

Acute peritoneal dialysis: advantages and disadvantages in the treatment of patients with acute kidney injury
(Akutna peritoneumska dijaliza: prednosti i nedostaci u lečenju bolesnika sa akutnim oštećenjem bubrega)

Dejan Petrović(1), Biserka Tirmenštajn Janković(2), Milenko Živanović(2), Aleksandra Nikolić(3), Mileta Poskurica(1)
(1) Klinički centar Kragujevac, Centar za nefrologiju i dijalizu, Klinika za urologiju i nefrologiju, (2) Zdravstveni centar Zaječar, Odeljenje za hemodijalizu, (3) Klinički centar Kragujevac, Klinika za internu medicinu


Indications for acute peritoneal dialysis (PD) are renal (clinical manifestations of uremic syndrome, oliguria in hemodynamically unstable patients, presence of a bleeding diathesis or hemorrhagic conditions, difficulty in obtaining blood access) and non-renal (refractory congestive cardiac failure, hypervolemia resistant to diuretic therapy, poisoning, acute pancreatitis, acute hepatic failure, clinically significant hypothermia and hyperthermia). The advantages of PD are the following: it is universally available and easy to initiate because of its technical simplicity, it does not require specialized equipment, vascular access, systemic anticoagulation, there is no interaction between blood and dialysator, there is a gradual removal of uremic toxins and substances and it enables gradual removal of large quantity of fluids. Major limitations of acute PD are the following: the necessity for an intact peritoneal cavity with adequate peritoneal clearance capacity, the use of intraperitoneal fluid may increase intra-abdominal pressure, the rise in intra-abdominal pressure may have deleterious effects in patients with acute lung injury or the acute respiratory distress syndrome, the rise in ventilation pressure in pa-tients on mechanical respiratory, non precise control of ultrafiltration, inadequate clearance of uremic toxins in patients with hypercatabolic state, inadequate clearance of medium molecular weight uremic toxins and in-flammatory mediators, the risk of peritonitis, increased protein loss. Contraindications of acute PD are the following: recent abdominal or cardiothoracic surgery, diaphragmatic peritoneopleural connections, abdominal wall cellulitis, fungal peritonitis, severe respiratory failure, abdominal aortic graft, severe gastroesophageal reflux disease, extremely hypercatabolic state, life-threatening hyperkalemia, and severe acute pulmonary edema. The major available techniques for acute PD are the following: acute intermittent PD, chronic equilibrated PD, tidal PD, high-volume PD, and continuous flow PD. High-volume PD is a good alternative for daily hemodialysis and continuous renal replacement therapies in patients with acute kidney injury.
Key words: acute kidney injury, acute peritoneal dialysis, adequate dialysis

Napomena: kompletan tekst rada na srpskom jeziku
Note: full text in Serbian

      Corresponding Address:
Dejan Petrović
KC Kragujevac
Centar za nefrologiju i dijalizu
Klinika za urologiju i nefrologiju
Zmaj Jovina 30, 34000 Kragujevac
Tel.: 034/370-302, Faks: 034-370-302
Paper received: 24. 01. 2012
Paper accepted: 11. 04. 2012
Paper Internet issues: 10. 06. 2012
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Timočki medicinski glasnik, Zdravstveni centar Zaječar
Journal of Regional section of Serbian medical association in Zajecar
Rasadnička bb, 19000 Zaječar, Srbija

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