Complication Management in Acute PD (UF Failure, Acidosis, Lytes, Peritonitis)
18 Sep 2026
11:10
11:50
Yu-Cyuan Hong
Speaker
Complication Management in Acute PD (UF Failure, Acidosis, Lytes, Peritonitis)Acute peritoneal dialysis remains a practical option for AKI when hemodynamic instability, coagulopathy, absent vascular access, or resource constraints limit extracorporeal therapy. Its complication profile, however, differs from that of chronic PD: the catheter is freshly placed, the membrane is acutely inflamed and often high-transport, exchanges are rapid and hypertonic.
First, inadequate ultrafiltration is separated into mechanical causes (catheter malposition, omental wrap, leak to pleural or subcutaneous tracking) and membrane-prescription causes. Management follows from that division — imaging and repositioning, or shortened dwell and adjusted tonicity — rather than reflexive escalation of dextrose concentration.
Electrolyte complications follow directly from the prescription: hypokalemia from potassium-free dialysate compounded by glucose-driven intracellular shift; hypernatremia from sodium sieving during short hypertonic dwells;
Peritonitis in acute PD differs from its chronic counterpart. Risk is front-loaded by bedside insertion, immediate use, and repeated manual exchanges, so prevention rests on closed connectology, cycling, and minimal manipulation. Short dwells dilute the effluent cell count, making neutrophil percentage more reliable than the absolute number; in a sedated septic patient the first sign may be falling ultrafiltration.