Automated peritoneal dialysis-current status

During the past years automated peritoneal dialysis (APD) has become increa singly important for the treatment of end-stage renal disease patients. Thi s article gives an overview of important clinical aspects of the different APD modalities. Controversial results are published about the influence of APD on residual renal function, showing both a negative influence of APD co mpared to continuous ambulatory peritoneal dialysis (CAPD), as well as no d ifferences between CAPD and APD. Recent studies suggest that the risk of pe ritonitis is lower in APD than in CAPD. APD patients have more time availab le for their work and their social relationships than CAPD patients, but th ey tend to have more sleeping problems. Recent studies show that tidal peri toneal dialysis (TPD) does not provide better small-solute clearance than c onventional APD regimes using a comparable dialysate flow. In future, recir culation peritoneal dialysis (RPD) with continuous flow using a double lume n peritoneal catheter may be a more effective tool to intensify peritoneal dialysis. During RPD peritoneal clearance may be two or three times higher than with intermittent flow techniques. However, some questions remain unso lved, e.g. influence of the high dialysate flow on peritoneal cells and hos t defence. Newer dialysate solutions may prevent technical drop-out in APD patients. Continuous cyclic peritoneal dialysis (CCPD) patients using gluco se polymer solutions during the daytime dwell show better ultrafiltration a nd higher creatinine clearances than those using conventional glucose dialy sate soutions. APD using bicarbonate solution provides more effective treat ment of metabolic acidosis than using lactate solution. In future, cyclers with PC-card and adequate software will allow better patient monitoring and management of PD-associated complications. The main indications for APD ar e inadequate clearance on CAPD, ultrafiltration failure due to high periton eal transport rates or due to mechanical outflow problems, social reasons s uch as more flexibility for employment or for the person helping to perform the dialysis, and complications due to the increased intraperitoneal press ure, which is higher during CAPD than during APD. On the other hand, in pat ients with low peritoneal transport rates or in those who reject dependence on a dialysis machine, CAPD should be preferred.