Back to the future: a review of peritoneal dialysis for acute kidney injury.

PURPOSE OF REVIEW: Acute kidney injury requiring dialysis (AKI-D) is a growing global health problem with high mortality. This perspective re-evaluates the role of acute peritoneal dialysis in the modern management of AKI-D, challenging the prevailing extracorporeal paradigm and highlighting its potential in various clinical scenarios.

RECENT FINDINGS: We review the current evidence comparing peritoneal dialysis to other renal replacement therapies, demonstrating comparable outcomes in many cases. We discuss the advantages of peritoneal dialysis, including hemodynamic stability, avoidance of anticoagulation, and cost-effectiveness, which make it an ideal choice for specific patient populations and in resource-limited settings. We explore the history of underutilization and provide concrete guidance on prescribing acute peritoneal dialysis.

SUMMARY: Peritoneal dialysis is a versatile and effective therapy for AKI-D that deserves renewed consideration. A paradigm shift is needed to integrate acute peritoneal dialysis into mainstream clinical practice through enhanced education, robust research, and the development of standardized protocols.