{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:10:45Z","timestamp":1791407445942,"version":"4.3.3"},"reference-count":77,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T00:00:00Z","timestamp":1606953600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perit Dial Int"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary statements<\/jats:title>\n                    <jats:p>(1)\u2002Peritoneal dialysis (PD) should be considered a suitable modality for treatment of acute kidney injury (AKI) in all settings (1B).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Guideline 2: Access and fluid delivery for acute PD in adults<\/jats:title>\n                    <jats:p>(2.1)\u2003Flexible peritoneal catheters should be used where resources and expertise exist (1B) (optimal). (2.2)\u2003Rigid catheters and improvised catheters using nasogastric tubes and other cavity drainage catheters may be used in resource-poor environments where they may still be life-saving (1C) (minimum standard). (2.3)\u2003We recommend catheters should be tunnelled to reduce peritonitis and peri-catheter leak (practice point). (2.4)\u2003We recommend that the method of catheter implantation should be based on patient factors and locally available skills (1C). (2.5)\u2003PD catheter implantation by appropriately trained nephrologists in patients without contraindications is safe and functional results equate to those inserted surgically (1B). (2.6)\u2003Nephrologists should receive training and be permitted to insert PD catheters to ensure timely dialysis in the emergency setting (practice point). (2.7)\u2003We recommend, when available, percutaneous catheter insertion by a nephrologist should include assessment with ultrasonography (2C). (2.8)\u2003Insertion of PD catheter should take place under complete aseptic conditions using sterile technique (practice point). (2.9)\u2003We recommend the use of prophylactic antibiotics prior to PD catheter implantation (1B). (2.10)\u2002A closed delivery system with a Y connection should be used (1A) (optimal). In resource poor areas, spiking of bags and makeshift connections may be necessary and can be considered (minimum standard). (2.11)\u2002The use of automated or manual PD exchanges are acceptable and this will be dependent on local availability and practices (practice point).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Guideline 3: Peritoneal dialysis solutions for acute PD<\/jats:title>\n                    <jats:p>(3.1)\u2002In patients who are critically ill, especially those with significant liver dysfunction and marked elevation of lactate levels, bicarbonate containing solutions should be used (1B) (optimal). Where these solutions are not available, the use of lactate containing solutions is an alternative (practice point) (minimum standard). (3.2)\u2002Commercially prepared solutions should be used (optimal). However, where resources do not permit this, then locally prepared fluids may be life-saving and with careful observation of sterile preparation procedure, peritonitis rates are not increased (1C) (minimum standard). (3.3)\u2002Once potassium levels in the serum fall below 4 mmol\/L, potassium should be added to dialysate (using strict sterile technique to prevent infection) or alternatively oral or intravenous potassium should be given to maintain potassium levels at 4 mmol\/L or above (1C). (3.4)\u2002Potassium levels should be measured daily (optimal). Where these facilities do not exist, we recommend that after 24 h of successful dialysis, one consider adding potassium chloride to achieve a concentration of 4 mmol\/L in the dialysate (minimum standard) (practice point).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Guideline 4: Prescribing and achieving adequate clearance in acute PD<\/jats:title>\n                    <jats:p>\n                      (4.1)\u2002Targeting a weekly K\n                      <jats:sub>t<\/jats:sub>\n                      \/ V\n                      <jats:sub>urea<\/jats:sub>\n                      of 3.5 provides outcomes comparable to that of daily HD in critically ill patients; targeting higher doses does not improve outcomes (1B). This dose may not be necessary for most patients with AKI and targeting a weekly K\n                      <jats:sub>t<\/jats:sub>\n                      \/ V of 2.2 has been shown to be equivalent to higher doses (1B). Tidal automated PD (APD) using 25 L with 70% tidal volume per 24 h shows equivalent survival to continuous venovenous haemodiafiltration with an effluent dose of 23 mL\/kg\/h (1C). (4.2)\u2002Cycle times should be dictated by the clinical circumstances. Short cycle times (1\u20132 h) are likely to more rapidly correct uraemia, hyperkalaemia, fluid overload and\/or metabolic acidosis; however, they may be increased to 4\u20136 hourly once the above are controlled to reduce costs and facilitate clearance of larger sized solutes (2C). (4.3)\u2002The concentration of dextrose should be increased and cycle time reduced to 2 hourly when fluid overload is evident. Once the patient is euvolemic, the dextrose concentration and cycle time should be adjusted to ensure a neutral fluid balance (1C). (4.4)\u2002Where resources permit, creatinine, urea, potassium and bicarbonate levels should be measured daily; 24 h K\n                      <jats:sub>t<\/jats:sub>\n                      \/ V\n                      <jats:sub>urea<\/jats:sub>\n                      and creatinine clearance measurement is recommended to assess adequacy when clinically indicated (practice point). (4.5)\u2002Interruption of dialysis should be considered once the patient is passing &gt;1 L of urine\/24 h and there is a spontaneous reduction in creatinine (practice point).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>The use of peritoneal dialysis (PD) to treat patients with acute kidney injury (AKI) has become more popular among clinicians following evidence of similar outcomes when compared with other extracorporeal therapies. Although it has been extensively used in low-resource environments for many years, there is now a renewed interest in the use of PD to manage patients with AKI (including patients in intensive care units) in higher income countries. Here we present the update of the International Society for Peritoneal Dialysis guidelines for PD in AKI. These guidelines extensively review the available literature and present updated recommendations regarding peritoneal access, dialysis solutions and prescription of dialysis with revised targets of solute clearance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0896860820970834","type":"journal-article","created":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T04:53:42Z","timestamp":1606971222000},"page":"15-31","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":106,"title":["ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update (adults)"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8909-686X","authenticated-orcid":false,"given":"Brett","family":"Cullis","sequence":"first","affiliation":[{"name":"Renal and Intensive Care Unit, Hilton Life Hospital, South Africa"},{"name":"Department of Renal and Solid Organ Transplantation, Red Cross War Memorial Childrens Hospital, University of Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5494-1963","authenticated-orcid":false,"given":"Abdullah","family":"Al-Hwiesh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kajiru","family":"Kilonzo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2876-4785","authenticated-orcid":false,"given":"Mignon","family":"McCulloch","sequence":"additional","affiliation":[{"name":"Department of Renal and Solid Organ Transplantation, Red Cross War Memorial Childrens Hospital, University of Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdou","family":"Niang","sequence":"additional","affiliation":[{"name":"Nephrology Department, Cheikh A. Diop University, Dakar, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5456-4456","authenticated-orcid":false,"given":"Peter","family":"Nourse","sequence":"additional","affiliation":[{"name":"Department of Renal and Solid Organ Transplantation, Red Cross War Memorial Childrens Hospital, University of Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8758-7382","authenticated-orcid":false,"given":"Watanyu","family":"Parapiboon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Maharat Nakhonratchasima Hospital, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6178-6938","authenticated-orcid":false,"given":"Daniela","family":"Ponce","sequence":"additional","affiliation":[{"name":"Botukatu School of Medicine, Sao Paulo, 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