Acute kidney injury (AKI) is an important cause of morbidity and mortality among hospitalized patients, particularly those with critical illness and multiple organ dysfunction. When severe AKI produces complications that cannot be managed conservatively, renal replacement therapy (RRT) may be required. The choice of modality is influenced by hemodynamic status, clinical indication, local expertise, and availability of equipment and trained staff.

Peritoneal dialysis (PD) provides a non-extracorporeal route for solute and fluid removal. In settings where access to hemodialysis or continuous kidney replacement therapy is constrained, PD may be a feasible option. Its role and outcomes in critically ill patients, however, depend on patient selection, the prescription and delivery of dialysis, underlying illness, and complications.

This study describes the outcomes of patients with AKI treated with acute intermittent peritoneal dialysis at a tertiary-care hospital in Salem, Tamil Nadu, with particular attention to hospital survival, conversion to hemodialysis, and selected clinical characteristics.

Study design and setting This was a prospective observational study conducted over 12 months, from January 2021 to January 2022, in the Department of Nephrology at Government Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu, India. Participants The thesis reports a sample of 50 patients aged 12 years or older with clinically, biochemically, and sonologically established AKI who received AIPD. Patients of either sex were eligible. Patients who refused participation, those with chronic kidney disease, and those with acute-on-chronic kidney disease were excluded. The thesis states that institutional ethics committee approval was obtained and written informed consent was obtained from patients or their relatives when patients were critically ill. Data collection and outcomes Demographic characteristics, symptom history, comorbidities, vital signs, urine output, serial serum creatinine and electrolytes, hypotension, vasopressor (inotrope) support, oxygen or ventilatory support, intensive care requirements, encephalopathy, and coagulopathy were recorded. Patients were followed during hospitalization until discharge or death. AIPD was initiated according to clinical indications and institutional protocol. The prespecified outcomes described in the thesis included survival/death and conversion to HD. The source thesis also labels 38 patients as “completely recovered”; because a clear definition of renal recovery and post-discharge kidney function is not supplied, this manuscript reports the 38/50 outcome as survival rather than confirmed complete renal recovery. Statistical analysis The source thesis reports data entry in Microsoft Excel and analysis using STATA version 10.1. Categorical variables were summarized as frequencies and percentages. Chi-square tests were used for selected comparisons, with p<0.05 considered statistically significant. Individual-level data were not available for independent re-analysis.

Patient characteristics

Fifty patients were included. Forty (80%) were male and 10 (20%) were female. Forty-three patients (86%) were younger than 60 years and seven (14%) were aged 60 years or older. The initial serum creatinine was below 3 mg/dL in 6 patients (12%), 3–6 mg/dL in 24 (48%), 6–10 mg/dL in 17 (34%), and above 10 mg/dL in 3 (6%).

Table 1. Baseline demographic and laboratory characteristics

Indications for AIPD

Uremia with oliguria was the most common recorded indication (36/50, 72%). Uremia with anuria was recorded in 6 patients (12%). Other indications were individually uncommon and included volume overload with uremic features, uremic symptoms, and uremic encephalopathy.

Table 2. Principal indications recorded for AIPD

Dialysis modality and hospital outcome

Twenty-three patients (46%) were converted from AIPD to HD, while 27 (54%) were reported as remaining on PD. Overall, 38 patients (76%) survived and 12 (24%) died during hospitalization. Among the 23 patients converted to HD, 16 (69.6%) survived and 7 (30.4%) died. The thesis reports 22 survivors and 5 deaths among patients treated with PD only, which accounts for 27 patients.

Table 3. Dialysis pathway and hospital outcome

Organ support and outcome

The thesis reports 22 patients (44%) receiving inotropic/vasopressor support, although the accompanying table lists 28 patients without support as 54%; the correct percentage for 28/50 is 56%. One table reports 18 ventilated patients, all receiving inotropic support, whereas another reports 12/50 (24%) on ventilatory support. Among the 18 patients described in the ventilator outcome table, 2 survived and 10 died while remaining on PD, and 1 survived and 5 died after conversion to HD. These counts sum to 18, but conflict with the separate report of 12 ventilated patients and should be checked against case records.

Creatinine and outcome

The thesis reports the following outcome counts by baseline creatinine: below 3 mg/dL, 6 survived and none died on PD, with 1 patient also listed as converted to HD; 3–6 mg/dL, 20 survived and 4 died, with 8 converted to HD; 6–10 mg/dL, 11 survived and 6 died, with 12 converted to HD; and above 10 mg/dL, 1 survived and 2 died, with 2 converted to HD. Reported p-values for the creatinine-group comparisons were 0.44, 0.08, 0.15, and 0.15, respectively. These categories and outcome counts appear to overlap because the table does not make clear whether conversion to HD is mutually exclusive from survival and death categories; therefore, they are reproduced descriptively and should not be interpreted as a validated association.

Causes of death

The thesis describes deaths associated with comorbid diabetes/cardiovascular disease, operated perforation peritonitis, snakebite-associated AKI, and multiorgan dysfunction. The causes-of-death table is incomplete: the listed category counts do not account for all 12 deaths and the percentages are inconsistent in places. A definitive cause-specific mortality table cannot be prepared without checking the original patient records.

In this single-centre cohort of 50 patients with AKI treated with AIPD, the reported in-hospital survival was 76%, and 46% of patients were converted to HD during admission. Uremia with oliguria was the predominant recorded indication. These findings describe the experience of one tertiary-care service during a one-year period and suggest that AIPD was used both as a renal replacement modality and, for some patients, as an initial treatment before transition to extracorporeal dialysis. The 30.4% mortality among patients converted to HD should not be interpreted as evidence that conversion worsened outcome. Patients may have been converted because of greater illness severity, inadequate response, or other clinical indications, and the study does not report adjustment for these factors. Likewise, the outcomes of patients who remained on PD cannot be directly compared with those converted to HD because treatment allocation was not randomized and baseline severity may have differed. The results need cautious interpretation. The study is small and single-centre, and the thesis contains inconsistencies in ventilatory-support counts, percentage calculations, the definition of “complete recovery,” and the cause-of-death table. There is also limited detail on the AIPD prescription, dialysis dose, catheter technique, peritonitis or other adverse events, baseline AKI severity, and kidney function at discharge or follow-up. These items should be resolved before submission and would materially strengthen the paper.

Among 50 patients with AKI treated with AIPD at a tertiary-care hospital in Salem, 38 (76%) survived to hospital discharge and 23 (46%) were converted to HD. Uremia with oliguria was the most common recorded indication. As an uncontrolled observational study with data inconsistencies and no comparator group, these results should be considered descriptive and cannot establish the comparative effectiveness of AIPD. Verification of the source data and clearer reporting of renal recovery, dialysis prescription, and complications are required before publication.

Ethics approval and consent

The source thesis states that institutional ethics committee approval was obtained and written informed consent was obtained from participants or their relatives when participants were critically ill. The committee name, approval number, and approval date were not provided in the source material and must be added if available.

Funding

No financial support was received, according to the source thesis.

Conflicts of interest

Not reported in the source thesis. The author should confirm and insert the appropriate declaration.

Data availability

Not reported in the source thesis. Add a journal-appropriate statement after confirming whether de-identified data can be shared.

Acknowledgements

Not provided in the source thesis.