A 3-year-old male weighing 18 kg was transferred from his hospital of origin due to acute renal failure and septic shock (maximum noradrenaline 1 µg/kg/min, mechanical ventilation for 11 days, disseminated intravascular coagulation [DIC], positive blood culture for Streptococcus pyogenes). DPA was started at 36 h due to oligo-anuria (diuresis of 0.1 ml/kg/h) of 24 hours of evolution, net balance of +1,200 ml and creatinine increase (initial 0.7 mg/dl, later 2 mg/dl). On day 1, with ultrafiltrate of 685 ml in 24 h, with hourly passes of 12 ml/kg of 1.36% glucose, 20 minutes of permanence, the D/P urea and creatinine ratios were 0.73 and 0.6 respectively, with a Dt/Do glucose of 0.49, so we increased the permanence to 30 minutes and the volume to 17 ml/kg with the same type of liquid and hourly exchange, as we still had an osmotic gradient: we obtained an increase in daily ultrafiltrate up to 970 ml. Subsequently, the glucose concentration needed to be increased to 3.27% to maintain effective ultrafiltration. On day 12, with passes every 2 h of 3.27% fluid, 40 min dwell time, with 12 ml/kg, the D/P ratios of urea, creatinine and Dt/Do glucose were 0.94, 0.85 and 0.16 respectively, so we decreased the concentration to 2.27% (in such a permeable peritoneum such a hypertonic solution may not be necessary) and increased the dwell time to 60 min (passes every 2 h), obtaining ratios of 0.96, 0.85 and 0.22 respectively (with a less concentrated, less aggressive fluid, we still obtained a similar clearance), with a decrease in creatinine in 36 h from 5.5 mg/dl to 4 mg/dl (renal function of 8 ml/min/ 1.73 m2 by urinary creatinine clearance and 10 ml/min/1.73 m2 by Schwarz formula). On day 15 the cellularity of the dialysate increased and on day 16 the peritoneal catheter was removed (growth of C. albicans).
