Kidney Week 2025 Annual Meeting-Re-Exploring Peritoneal Dialysis as a Treatment Option for AKI

Video Transcription

Video Summary

The session argues for expanding peritoneal dialysis (PD) use in acute kidney injury (AKI), drawing on experience from urgent-start PD and international data. Dr. Arshia Ghaffari reviewed PD’s historical role in AKI, its decline in high-resource countries due to extracorporeal therapies, and new U.S. policy changes: CMS now covers home dialysis modalities for AKI (2025), creating an opportunity to use PD and reduce central venous catheter (CVC) exposure. He emphasized that many dialysis-dependent AKI (AKID) patients never recover—about half are labeled ESKD within six months—so early in-hospital education about long-term options (including home therapies) is crucial. Evidence from urgent-start PD suggests comparable or better outcomes versus urgent hemodialysis, with fewer bloodstream infections, fewer mechanical complications, fewer hospitalizations, and lower early costs.<br /><br />Dr. Watanya Paripiboon explained why PD for AKI is far more common in Thailand (reported up to ~40% vs <1% globally): a strong PD-first national infrastructure, resource constraints that make PD an efficient alternative when CRRT is unavailable, and locally generated research. Key enablers include bedside catheter placement (ideally by nephrologists), simple manual exchanges performed by ward/ICU nurses, and smoother transition to chronic PD when recovery is unlikely.<br /><br />Dr. Jeff Bull advocated continuing maintenance PD in critically ill patients rather than reflexively switching to hemodialysis/CRRT, citing observational data showing similar or better post–cardiac surgery outcomes and minimal demonstrated harm to respiratory mechanics, even in ventilated or prone patients, when prescribed appropriately.<br /><br />Dr. Daniela Ponce summarized ISPD AKI-PD guideline evidence: randomized trials and meta-analyses show no mortality difference between PD and extracorporeal therapies. Flexible catheters, closed systems, commercial solutions, and prescriptions targeting adequate clearance (often Kt/V tailored to severity) are recommended, with attention to complications (leaks, peritonitis, hyperglycemia, hypokalemia). The overarching message: PD is a viable, scalable AKI therapy when infrastructure, catheter access, and training are addressed.

Asset Subtitle

Moderator(s): Shina Menon, Jeffrey Perl

Presentation(s):

Making the Case for Peritoneal Dialysis in AKI Care: Lessons from an Urgent Start Program - Arshia Ghaffari
Peritoneal Dialysis for AKI: The Thailand Experience - Watanyu Parapiboon
Peritoneal Dialysis in the Intensive Care Unit: Time for a Critical Re-Evaluation - Jeffrey Perl
International Society for Peritoneal Dialysis: Guidelines for Peritoneal Dialysis in AKI - Daniela Ponce

Meta Tag

Date 11/7/2025

Pathway 1 AKI and Critical Care

Pathway 2 Dialysis

Session ID 507315

Keywords

peritoneal dialysis

acute kidney injury

AKI dialysis

urgent-start peritoneal dialysis

AKI-D (dialysis-dependent AKI)

CMS coverage home dialysis for AKI 2025

central venous catheter avoidance

bloodstream infection reduction

Thailand PD-first infrastructure

bedside PD catheter placement

ICU peritoneal dialysis in critically ill

ISPD AKI-PD guidelines

Kt/V clearance prescription