AKI refers to any cause that leads to an abrupt decrease in renal blood volume and structural changes in the kidney. The key to the treatment of AKI is to improve the ischemic state of renal tissue as soon as possible and to promote the early restoration of renal structure and function. The majority of AKI cases in China are due to renal parenchymal disease. According to recent literature, 82.2% of all AKI is due to renal parenchymal disease, among which drug-induced tubulopathy is the most common, followed by ischemia or infection, while only a very small percentage of severe AKI is due to MOF. Although there is no unified standard on how to apply renal replacement therapy (timing, modality and dose of dialysis, etc.) in patients with AKI syndrome, from the epidemiological perspective of AKI in China, the vast majority are still single organ damage and all have obvious causative factors. From this perspective, PD can be the preferred option for most AKI patients. In terms of the therapeutic principle of PD, the use of one’s own peritoneum as a dialysis membrane provides a continuous and uninterrupted treatment process with minimal systemic hemodynamic changes.
During the PD process, it is not only able to play its role in removing nitrogen metabolites, but more importantly, the treatment process can correct the disturbance of the internal environment and maintain the balance of the body’s internal volume status, acid-base and electrolytes. Therefore, it is very beneficial to the recovery of damaged organ tissue structure and function. It has also been shown that compared with HD, PD has a certain effect on the clearance of inflammatory mediators in the body, in addition to the dominant effect on the clearance of medium and large metabolites, especially in patients with AKI.
Renal function recovers more quickly. With the introduction of automated peritoneal dialysis (APD) machines into the clinical setting, the advantages of APD for AKI have become more apparent.
The advantages of APD for AKI are not only the freedom to choose or adjust the dose more easily, but also the availability of more dialysis modalities, which makes the whole treatment plan more individualized and greatly shortens the gap between APD and other CRRT modalities for AKI.
The gap between PD and other CRRT modalities in the treatment of AKI is greatly reduced. Thus, PD has a very broad application for most AKI patients and deserves the attention and research of clinicians.