Peritoneal dialysis (PD) is an effective renal replacement therapy used in acute kidney injury (AKI) and certain emergency situations where rapid correction of fluid, electrolyte, and toxin imbalance is required. Unlike hemodialysis, which relies on a machine and vascular access, PD utilizes the patient’s own peritoneal membrane as a natural semipermeable filter. A catheter is inserted into the abdominal cavity, and a specially formulated dialysis fluid is infused. This fluid absorbs waste products and excess electrolytes through diffusion and osmosis. After a dwell period, the fluid is drained, removing toxins from the body. This cycle may be performed manually or using automated machines.
Acute PD is particularly beneficial in hemodynamically unstable patients, children, and individuals with limited access to advanced dialysis equipment. It offers gentle, continuous removal of solutes without sudden shifts in blood pressure. PD is also advantageous in settings with limited resources, as it does not require electricity, highly trained personnel, or complex infrastructure. It is often used when immediate dialysis is needed and hemodialysis access is not yet available.
The procedure is associated with fewer cardiovascular complications because the fluid exchange happens slowly and steadily compared to rapid solute removal seen in conventional hemodialysis. It can help correct metabolic acidosis, hyperkalemia, and fluid overload effectively. The peritoneal membrane provides a large surface area for filtration, making it suitable for acute metabolic control.
However, PD has limitations. The clearance capacity is lower than that of hemodialysis, which may be insufficient for patients with severe catabolic states. There is also a risk of infection, particularly peritonitis, if sterile techniques are not followed strictly. Abdominal pain, catheter malfunction, and incomplete drainage may occur. In addition, PD may not be suitable for patients with abdominal surgeries, adhesions, or hernias.
Despite these limitations, acute PD remains a valuable modality due to its simplicity, cost-effectiveness, and gentler approach. It continues to play an important role in acute care, especially in pediatric units, developing regions, and emergency settings where rapid initiation of treatment is essential.
