Choice of Peritoneal Dialysis Technique: Intermittent or Continuous

Continuous Versus Intermittent Techniques

A continuous dialysis therapy represents a period of treatment spanning a full 24-hour period and usually is applied for several days in a row. Intermittent dialysis has a distinct beginning and end of therapy and usually is performed within a period measured in hours. Using these definitions for peritoneal dialysis (PD) in acute kidney injury (AKI) however makes it almost impossible to distinguish between the two modalities. In the early days of PD in patients with severe uremia, the treatment often consisted of hourly exchanges during a period of 72 hours as maximum, because a longer duration was associated with a higher risk of peritonitis. However, these results were obtained with stylet catheters placed percutaneously at the bedside. These restrictions do not apply to the polymeric silicone (Silastic) Tenckhoff catheters currently used, especially when they are inserted via mini-laparotomy or laparoscopy. It follows from these considerations that PD in the intensive care unit (ICU) should be continuous whenever possible. This chapter focuses on the duration of the dialysis dwells.