Peritoneal dialysis in the intensive care setting: historical and contemporary insights after the COVID-19 pandemic

Peritoneal dialysis (PD) has been used since 1946 as a treatment for acute renal failure (ARF). Despite a decline in its use in favor of extracorporeal techniques in high-income countries, it is experiencing a resurgence of interest, thanks in particular to its adaptability to health crises. The COVID-19 pandemic has highlighted its strategic and complementary role, particularly in intensive care, where it can be used to compensate for the saturation of hemodialysis (HD) and continuous renal replacement therapy (CRRT) resources. In addition, recent studies and randomized controlled trials suggest that PD offers survival and renal recovery outcomes comparable to HD or continuous hemofiltration. However, PD remains underused in intensive care, hampered by negative perceptions and organizational barriers, and perpetuated by a lack of general exposure to the technique in intensive care units, not only among intensivists but also among nephrologistsThe variability in the adoption of PD at the international and regional levels reflects these cultural disparities, with low-resource countries or countries with a higher prevalence of PD (China, Mexico, Australia) often favoring it for its logistical simplicity and lower cost. Through a non-exhaustive review, this article examines the current place of PD in intensive care units, the associated clinical outcomes, the various barriers to its wider use, and potential solutions to promote the adoption of PD care for patients with renal failure (acute or chronic) hospitalized in intensive care units.