Emergency (****); * (*): *-* This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Copyright © 2014 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: www.jemerg.com Emergency (2014); 2(3): 106 106 EDITORIAL Peritoneal Dialysis as an Alternative Choice for Renal Replacement Therapy in Emergency Department Iraj Najafi* Shafa CAPD Research Center, Dialysis and Transplant Patients Association (DATPA), Tehran, Iran *Corresponding Author: Iraj Najafi; Department of Internal Medicine, Dr. Shariati Hospital, Tehran University of Medical Sci- ences, North Kargar Avenue, Tehran 14114 Iran. Tel/Fax: +98 21 22721155; Email: najafi63800@yahoo.com ncreasing the prevalence of renal failure cases need- ing renal replacement therapy (RRT) among refer- eeing to the emergency department highlights the preparation requirement for services giving to these patients. The limited number of hemodialysis machines, inaccessibility of dialysis machines in all hospitals, large number of patients, and shortage of expert personnel in this field are some of current problems of health centers to present services for these patients. Since hemodialy- sis units are usually reserved for patients with chronic renal failure as overnight and weekly base, this problem would be exacerbate when the subjects need emergent dialysis. On the other hand, in acute critical patients who have hemodynamic instability or heart failure, he- modialysis is not tolerable then not treatment of choice. Therefore, peritoneal dialysis can be considered as an alternative choice for emergent dialysis cases. The peri- toneal dialysis method is one of the effective treatment strategies for dialyzed patients without need of expen- sive machines and equipment. This method has been tested on human since 1923, in which blood purifica- tion is performed through peritoneal membrane. In some countries more than 90% of patients are dialyzed through this way (1, 2). Peritoneal dialysis is also ex- panding in Iran and based on the policy of ministry of health at least 15% of dialyzed patients are to be dia- lyzed using this method in the country. For the first time, peritoneal dialysis has been performed in Imam Reza hospital, Mashhad, Iran, in 1993 and then after in two peritoneal dialysis center of Tehran (3). Today PD has been accepted as an efficient and reliable alterna- tive way for RRT in acute as well as chronic renal fail- ure. Although there are several successful reports ap- plying the peritoneal dialysis even in hyperkalemia, acidosis, uremic syndrome, and etc. (4-8), It has less been considered as a current alternative therapy for emergent dialysis cases. Of course using this method is not limited only to the renal failure and can be used to remove dialyzable toxins such as barbiturates and eth- ylene glycol as well as treatment of severe electrolyte disturbance and peritonitis (1, 2). To reach this goal, bedside embedding peritoneal dialysis catheter is a crit- ical and non-negligible point on management of the pa- tients due to the dangerous situation of transporting these patients to operating room. We used to put a semi rigid temporary polyethylene catheter (Trocath) with guidance of stylet introducer which no have been re- placed by the flexible silicone rubber catheter intro- duced by Tenckhoff. It has many advantages in compar- ison with the trocath catheters. Its softness allows it to be tunneled subcutaneously in the anterior abdominal wall and its Dacron single cuff reduced the incidence of complications such as, leakage, accidental dislodgement and infection. These catheters can be inserted as a bed- side percutaneous procedure with local anesthesia as well as laparascopic and surgical methods. Based on the above mentioned data, it seems that training of sur- geons, internists, and emergency physicians regarding inserting percutaneously a PD catheter, and manage- ment of probable complications can be considered as essential steps toward a better handling of such an al- most large group of patients in emergency wards. References: 1. Avendano MBI, Solorzano GY, Valenzuela JR, et al. Automated peritoneal dialysis as a lifesaving therapy in an emergency room: Report of four cases. Kidney Int. 2008;73(S108):S173-S6. 2. Labato MA. Peritoneal dialysis in emergency and critical care medicine. Clin Tech Small Anim Pract. 2000;15(3):126- 35. 3. Mahdavi R, Naghib M. Kidney Transplantation In Children: Results Of Ten Years Experience In Imam Reza Hospital. Med J Islamic Repub Iran. 2002;16(3):145-9. 4. Kilonzo KG, Ghosh S, Temu SA, et al. Outcome of acute peritoneal dialysis in northern Tanzania. Perit Dial Int. 2012;32(3):261-6. 5. Ajaz SM, Pathan MS, Badaam KM. Clinical Profile, Etiological Factors and Outcome of Acute Renal Failure in Children: A Clinical Study. Hypertension. 2012;26:46.2. 6. Najafi I, Hakemi M, Safari S, et al. The story of continuous ambulatory peritoneal dialysis in Iran. Perit Dial Int. 2010;30(4):430-3. 7. Little D, Custer MD. Peritoneal Dialysis. Fundamentals of Pediatric Surgery: Springer; 2011. p. 553-7. 8. Akhlaghi AA, Najafi I, Mahmoodi M, Shojaee A, Yousefifard M, Hosseini M. Survival Analysis of Iranian Patients Undergoing Continuous Ambulatory Peritoneal Dialysis Using Cure Model. J Res Health Sci. 2013;13(1):32-6. I