The Kidney & Hypertension Group also uses Peritoneal Dialysis in the acute setting in cases of Acute Kidney Injury and Acute on Chronic Kidney Failure. Our retention of these patients who continue on renal replacement therapy in the PD program has been favorable. A recent Up-To-Date lists the following as benefits of using PD in the acute care setting:
1.It is widely available and technically easy to perform.
2.Large amounts of fluid can be removed in hemodynamically unstable patients; this fluid removal may also permit the administration of parenteral nutrition.
3.Disequilibrium syndrome is not precipitated because of slow rate of solute removal.
4.Easy and gradual correction of acid-base and electrolyte imbalance may be performed.
PD access placement is relatively easy, particularly in children.
5.Arterial or venous puncture and anticoagulation are not required.
6.It is a highly biocompatible technique.
7.Dosing is easy, particularly in children.
It is also less labor intense, a consideration for care that is to be delivered timely.
Our Clinical Nurse Specialist from our PD program is alerted once a patient in the acute setting is scheduled to receive a PD catheter, and she follows the patient’s progress through discharge. The formal education and training of the patient begins while the patient cycles in the outpatient setting. The use of “PD mentors”-PD patients who volunteer to contact acute start PD patients by phone-has been reported to influence patient acceptance of the technique. A home visit is scheduled prior to , or just following discharge when feasible.
Use of Social Media-in our case PD specific Facebook, Twitter and blog posts provide a sense of community and hope for patients who find themselves with this sudden “part time” job. Early discussion of Transplant-when appropriate-as an option has also been found to improve patient outlook.
