Urgent Start Peritoneal Dialysis: A Viable Option for Acute and Chronic Kidney Failure

Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to haemodialysis, not only in the chronic setting, but also in the acute. Recently, interest in using PD to manage acute kidney injury (AKI) patients has been increasing. Some Brazilian studies have shown that, with careful thought and planning, critically ill patients can be successfully treated with PD. To overcome some of the classic limitations of PD use in AKI, such as a high chance of infectious and mechanical complications, and no control of urea, potassium, and bicarbonate levels, the use of cycles, flexible catheters, and a high volume of dialysis fluid has been proposed. This knowledge can be used in the case of an unplanned start on chronic PD and may be a tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy. PD should be offered in an unbiased way to all patients starting unplanned dialysis, and without contraindications to PD. In the following manuscript, advances in technical aspects and the advantages and limitations of PD will be discussed, and recent literature on clinical experience with PD use in the acute and unplanned setting will be reviewed.