Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Peritoneal Dialysis in AKI and Critically Ill Patients

Video Transcription

Video Summary

Dr. Brett Cullis reviews peritoneal dialysis (PD) for acute kidney injury (AKI), especially in critically ill ICU patients and in low-resource settings. Although PD was once the most common AKI dialysis modality, it declined with the rise of continuous renal replacement therapy (CRRT). Cullis argues PD remains lifesaving where machines, electricity, water, supplies, and nephrologists are scarce. PD is cheaper, requires less staff training, is more hemodynamically stable, and can be improvised (e.g., alternative catheters and locally mixed fluids), helping address the large global AKI death burden.<br /><br />He challenges assumptions that higher extracorporeal “cytokine clearance” improves survival and notes extracorporeal circuits can trigger inflammation, hypotension, arrhythmias, myocardial stunning, and bacteremia. Modern studies and randomized trials from Brazil, Saudi Arabia, and Thailand show PD provides adequate small-solute clearance, comparable survival to CRRT/hemodialysis, possibly faster kidney recovery, acceptable peritonitis rates, and feasibility in ventilated patients when intra-abdominal pressure is managed.<br /><br />Cullis summarizes ISPD guideline dosing (often targeting weekly Kt/V ≈2.1) and emphasizes bedside catheter insertion—ideally by nephrologists—to enable rapid starts. He highlights the Saving Young Lives program training clinicians globally, and future needs: better adequacy metrics, improved fluids and devices, and tools to optimize ultrafiltration in real time.

Asset Subtitle

Brett Cullis

Meta Tag

Module DIAL

Speaker Brett Cullis

Keywords

peritoneal dialysis

acute kidney injury

ICU critically ill patients

low-resource settings

continuous renal replacement therapy

ISPD guidelines

weekly Kt/V dosing

Saving Young Lives program