ADEQUATE PERITONEAL-DIALYSIS - THE LIMITATIONS OF CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS (CAPD) AND THE PLACE OF AUTOMATED PERITONEAL-DIALYSIS (APD)

Recent epidemiological studies show a slowing down of the global growt h of CAPD which is not compensated by the considerable development of APD. These modifications are the result of the arrival of technologies which allow new strategies as well as an improved knowledge of tie ad equate dialysis dose for PD. The re-evaluation of the adequate clearan ce tar gets show that CAPD does not deliver an adequate dialysis dose for anuric patients but it remains an excellent technique for patients with residual renal function. HPD and mixed techniques (APD with auto mated diurnal exchange(s), CAPD with automated nocturnal exchange) can deliver an adequate diary sis dose if the peritoneal permeability is not too low and if the prescription is adapted to each patient. The gr owth of CAPD seems to be slowing down due to a better knowledge of its limitations. However the develoment of APD does not seem to be relate d to the increasing knowledge of its possibilities. The development of automated techniques, prescribed as substitute treatments, depends on a precise evaluation of the cost/efficiency/quality of life index, co mpared to the reference treatment which is iterative hemodialysis.