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Kidney Week

Abstract: PO1168

Renal Outcomes and Safety Profile of Direct Peritoneal Resuscitation (DPR)

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Shivaraj, Kiran, Westchester Medical Center, Valhalla, New York, United States
  • Klein, Michael D., Westchester Medical Center, Valhalla, New York, United States
  • Coritsidis, George N., Westchester Medical Center, Valhalla, New York, United States
Background



DPR is a novel technique used after damage control surgery where peritoneal dialysis fluid is continuously irrigated and drained from the peritoneal cavity in a open abdomen. This has been shown to improve intestinal perfusion, leading to faster abdominal closure. We analyzed the safety profile in terms of changes in the electrolyte profile.

Methods



This is a retrospective study of 17 patients who underwent DPR. All were treated using Dianeal 2.5% Ca 2.5 PD fluid for 2-16 days. The renal outcomes were analyzed. Patients who did not develop AKI were studied further. We evaluated changes in the serum sodium, potassium, phosphorus, calcium,and magnesium levels. The trend of creatinine was also evaluated.

Results



Our study showed that the AKI occurred in 11/17 patients (64.7%) of which 5 (45%) required renal replacement. Of the 6 patients without AKI, 3 had a rising trend of sodium which needed correction. Potassium trended downward slightly. All patients had low calcium even prior to initiation of DPR possible releated to the underlying clinical diagnoses, and the creatinine trended downward with levels remaining in the normal range.

Conclusion

Frequent AKI in these critically ill patients was not unexpected. It is plausible, though not demonstrated, that DPR by its mechanism of visceral vasodilation may have reduced this incidence somewhat. The trend toward higher sodium could be due to increased ultrafiltration effects. The downward trend of creatinine could have resulted from increased clearance by DPR. All the patients had decreased ionized calcium. Though present at the outset, the lower calcium bath may have contributed to its persistence. Magnesium, phosphorus and potassium remained stable. Due the convective and diffusive effects of the PD fluid used, safe use requires close monitoring of electrolytes and ultrafiltration to prevent volume shift and dysnatremia. Hypocalcemia can be mitigated by using a high calcium PD solution such as Dianeal 3.5% Ca.