Urgent Implantation of Peritoneal Dialysis Catheter in Chronic Kidney Disease and Acute Kidney Injury-A Review

Abstract

Acute kidney injury (AKI) and sudden exacerbation of chronic kidney disease (CKD) frequently necessitate urgent kidney replacement therapy (UKRT). Peritoneal dialysis (PD) is recognized as a viable modality for managing such patients. Urgent-start peritoneal dialysis (USPD) may be associated with an increased number of complications and is rarely utilized. This review examines recent literature investigating the clinical outcomes of USPD in CKD and AKI. Relevant research was identified through searches of the MEDLINE (PubMed), Scopus, Web of Science, and Google Scholar databases using MeSH terms and relevant keywords. Included studies focused on the emergency use of peritoneal dialysis in CKD or AKI and reported treatment outcomes. While no official recommendations exist for catheter implantation in USPD, the impact of the technique itself on outcomes was found to be less significant compared with the post-implantation factors. USPD represents a safe and effective treatment modality for AKI, although complications such as catheter malfunctions, leakage, and peritonitis were observed. Furthermore, USPD demonstrated efficacy in managing CKD, although it was associated with a higher incidence of complications compared to conventional-start peritoneal dialysis. Despite its cost-effectiveness, PD requires greater technical expertise from medical professionals. Close supervision and pre-planning for catheter insertion are essential for CKD patients. Whenever feasible, an urgent start should be avoided. Nevertheless, in emergency scenarios, USPD does remain a safe and efficient approach.

Keywords: acute kidney injury; chronic kidney disease; peritoneal dialysis; urgent-start peritoneal dialysis.

Figure 1

Illustration of the occurrence rates of mechanical and infectious complications associated with various catheter placement methods in the adult population with CKD and AKI undergoing USPD. The chart is constructed using data extracted from Table 1 [37,44,46].

Figure 5

Representation of the frequency of mechanical complications in USPD and in conventional-start PD among individuals with CKD. The chart is constructed based on data derived from Table 5 [113,115,116,117].

Figure 6

Representation of the frequency of infectious complications in USPD and in conventional-start PD in CKD. The chart is derived from data presented in Table 5 [113,114,115,116].

Figure 2

Geographical representation of USPD use in AKI in pediatric and adult populations in different countries. Graphic representation of the data in Table 2.

Figure 3

Representation of the effectiveness and associated complications of USPD, USHD, and CRRT in the management of AKI. The chart is constructed using data obtained from Table 3, which includes studies providing sufficient information [35,38,42,86].

Figure 4

Representation of the occurrence rates of complications in USPD, USHD, and CRRT in AKI. Chart based on the data in Table 3, including studies with sufficient information. The chart is constructed using data obtained from Table 3, which includes studies providing sufficient information [35,42,77,86].