The Role of Peritoneal Dialysis in the Treatment of Acute Kidney Injury in Patients With Acute-on-Chronic Liver Failure: A Prospective Brazilian Study
| Autor: | Dayana Bitencourt Dias, André Luis Balbi, Daniela Ponce, Welder Zamoner, Erica Pires da Rocha, Christiane Akemi Kojima |
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| Přispěvatelé: | Universidade Estadual Paulista (UNESP) |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Medicine (General) Cirrhosis medicine.medical_treatment liver cirrhosis acute-on-chronic liver disease Gastroenterology Peritoneal dialysis Liver disease R5-920 Internal medicine medicine Dialysis Original Research business.industry Acute kidney injury General Medicine medicine.disease mortality Uremia acute kidney injury peritoneal dialysis Medicine business Hypervolemia Fluid balance |
| Zdroj: | Frontiers in Medicine Frontiers in Medicine, Vol 8 (2021) Scopus Repositório Institucional da UNESP Universidade Estadual Paulista (UNESP) instacron:UNESP |
| ISSN: | 2296-858X |
| Popis: | Made available in DSpace on 2022-04-29T08:35:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-23 This study aimed to explore the role of peritoneal dialysis (PD) in acute-on-chronic liver disease (ACLD) in relation to metabolic and fluid control and outcome. Fifty-three patients were treated by PD (prescribed Kt/V = 0.40/session), with a flexible catheter, tidal modality, using a cycler and lactate as a buffer. The mean age was 64.8 ± 13.4 years, model of end stage liver disease (MELD) was 31 ± 6, 58.5% were in the intensive care unit, 58.5% needed intravenous inotropic agents including terlipressin, 69.5% were on mechanical ventilation, alcoholic liver disease was the main cause of cirrhosis and the main dialysis indications were uremia and hypervolemia. Blood urea and creatinine levels stabilized after four sessions at around 50 and 2.5 mg/dL, respectively. Negative fluid balance (FB) and ultrafiltration (UF) increased progressively and stabilized around 3.0 L and −2.7 L/day, respectively. Weekly-delivered Kt/V was 2.7 ± 0.37, and 71.7% of patients died. Five factors met the criteria for inclusion in the multivariable analysis. Logistic regression identified as risk factors associated with Acute Kidney Injury (AKI) in ACLD patients: MELD (OR = 1.14, CI 95% = 1.09–2.16, p = 0.001), nephrotoxic AKI (OR = 0.79, CI 95% = 0.61–0.93, p = 0.02), mechanical ventilation (OR = 1.49, CI 95% = 1.14–2.97, p < 0.001), and positive fluid balance (FB) after two PD sessions (OR = 1.08, CI 95% = 1.03–1.91, p = 0.007). These factors were significantly associated with death. In conclusion, our study suggests that careful prescription may contribute to providing adequate treatment for most Acute-on-Chronic Liver Failure (ACLF) patients without contraindications for PD use, allowing adequate metabolic and fluid control, with no increase in the number of infectious or mechanical complications. MELD, mechanical complications and FB were factors associated with mortality, while nephrotoxic AKI was a protective factor. Further studies are needed to better investigate the role of PD in ACLF patients with AKI. Department of Internal Medicine Botucatu Medical School – University of São Paulo State – UNESP Botucatu Medical School – University of São Paulo State – UNESP Department of Internal Medicine Botucatu Medical School – University of São Paulo State – UNESP Botucatu Medical School – University of São Paulo State – UNESP |
| Databáze: | OpenAIRE |
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