Use of peritoneal dialysis and mesothelium in non primary renal conditions.

The management of a handful of non renal clinical conditions includes peritoneal dialysis (PD) as a therapeutic tool. Peritoneal lavage after abdominal surgery is still performed in infectious peritonitis and cases of necrotizing hemorrhagic pancreatitis. Use of PD in active psoriasis resulted in approximately 40 papers reporting mostly isolated cases and showing both therapeutic success and failure. That ambiguous picture persisted during controlled studies, and interest in treating psoriasis with PD faded over the last 20 years. As an emergency tool, PD has been also used in the treatment of metabolic crisis resulting from inborn errors of metabolism such as deficiency of any of the five enzymes of the urea cycle and other inherited disorders of organic and aminoacid metabolism such as maple syrup urine disease, citrullinemia, and propionic acidemia. Recent studies have shown that continuous hemofiltration therapies have more effective clearances than PD does. Similar observations were reported for the use of PD in drug poisoning. Peritoneal dialysis is still a valuable tool as a complementary measure in the treatment of hypothermia. Recently, prospective work in patients affected by end-stage congestive heart failure has shown that maintenance PD significantly lowers morbidity and mortality and substantially improves functional capabilities and quality of life in these otherwise terminally ill patients.