Automated Peritoneal Dialysis

In the last few years, automated peritoneal dialysis (APD) has undergone considerable improvements due to technological developments. The definition of a minimal dose of peritoneal dialysis (PD) has not yet been completely assessed. Appropriate use of APD requires an evaluation of dialytic efficiency in terms of dialytic indexes and their targets. Many dialytic treatment modalities have been performed in order to achieve adequacy targets. Some aspects have to be taken into consideration to reach the optimal dialytic dose: optimizing mass transfer in correlation with intraperitoneal volumes, prescribing tailored treatment modalities according to different characteristics of peritoneal membranes and individual patient needs, and performing more biocompatible treatments using different glucose profiling and alternative physiologic PD fluids. New high-flow techniques such as continuous flow PD can ensure better urea and creatinine clearances and ultrafiltration rates, leading to a higher utilization of the APD modality.

Section: New Pd Techniquesmentioning

confidence: 99%

Automated Peritoneal Dialysis Symposium: APD Prescription: Achieving the Adequacy Goals

Dell’Aquila

Bordoni

D'Intini

et al. 2002

“…It seems difficult to expand the population treated with PD beyond a certain limit (1–8). A new PD technique might contribute to an increase in the enrollment of patients in PD, although in most cases patients selected for new PD schedules are often chosen among those already treated with PD.…”

Section: The Number Of Pd Patients Is Reaching a Plateaumentioning

confidence: 99%

Continuous Flow Peritoneal Dialysis: Is There a Need for it?

Ronco

2001

Automated peritoneal dialysis (APD) is the fastest growing technique of peritoneal dialysis. However, recently APD has displayed some limitations imposed by the characteristics of the technique and by the characteristics of the peritoneal membrane of some patients. In general, the advent of a new technique such as continuous flow peritoneal dialysis (CFPD) should be seen as a benefit for several patients based on different considerations: CFPD is a high-efficiency technique which could overcome some of the limitations imposed by other techniques in terms of adequacy targets and performance. CFPD may become a useful tool to keep patients on PD who would otherwise be transferred to hemodialysis. CFPD may present advantages in terms of biocompatibility and also in terms of the possible modulation of the peritoneal solution to patient needs. Recent developments in technology seem to have made CFPD easily feasible and well tolerated. A new era of PD is probably beginning and CFPD will definitely represent one of the key issues in the future of PD.

“…Continuous ambulatory peritoneal dialysis (CAPD) in patients with high solute transport and devoid of residual renal function is associated with poor clinical outcomes (1). Automated peritoneal dialysis (APD) has the potential to improve both solute clearances and ultrafiltration (UF), particularly in patients with a high transport status (2,3). This was demonstrated during the first prospective, multicenter European Automated Peritoneal Dialysis Outcome Study (EAPOS), where a high proportion of anuric patients on APD were shown to achieve dialysis dose and UF targets by different treatment regimens (4).…”

mentioning

confidence: 99%

“…During this study directly comparing APD and CAPD, it was shown that APD was advantageous to CAPD in terms of quality of life and less physical and emotional discomfort was caused by dialysis itself, yet therapy costs were higher for APD (5). APD is the option of choice for a growing number of pediatric end‐stage renal disease (ESRD) patients, and during recent years APD has become the fastest‐growing PD modality worldwide (2–6).…”

mentioning

confidence: 99%

Automated Peritoneal Dialysis Symposium: Solutions for APD: Special Considerations

Passlick–Deetjen

Schaub

Schilling

2002

Automated peritoneal dialysis (APD) has become the fastest growing dialysis modality in Europe and the United States in recent years. Freedom from daytime exchanges, flexibility of prescription, performance in recumbent position leading to enhanced treatment efficacy, and a decreased incidence of peritonitis are the main advantages of APD over CAPD. Studies on new developments of glucose-based PD fluids were performed predominantly in CAPD patients. High volumes and frequent APD cycles in patients may aggravate the adverse effects of standard CAPD fluids on the peritoneal membrane with increasing time on PD. New, glucose-based PD fluids with neutral pH, very low concentrations of glucose degradation products (GDPs), containing either lactate or bicarbonate as buffering substances have been introduced into clinical use recently. With these new fluids, various in vitro, ex vivo, and in vivo studies could demonstrate a better preservation of peritoneal cell viability and growth, less inhibited secretory cell functions, a significant reduction in the formation of advanced glycation end products (AGEs), and clinical signs for an improved preservation of peritoneal mesothelial cells indicated by an increase in effluent CA125. One has to be aware, however, that uremia per se prior to initiation of PD, as well as during PD treatment itself, directly impacts on peritoneal membrane structural changes so that new, more biocompatible PD fluids may not be completely sufficient to prevent morphologic and functional changes of the membrane. Due to a strong sodium sieving during APD, PD fluids with sodium concentrations of 125-130 mmol/L may be beneficial. Systematic calcium kinetic studies have not yet been performed in APD patients. APD fluids should offer a calcium concentration range of 1.0-1.75 mmol/L in order to enable an individualized APD prescription. For long-term APD treatment, better knowledge of peritoneal membrane physiology and PD kinetics should promote individualization of prescriptions. New, pH-neutral PD solutions with minimized amounts of GDPs may be a significant step forward to improved membrane preservation during long-term APD treatment.