[Automated peritoneal dialysis--actual clinical aspects].
Automated peritoneal dialysis (APD) is an important treatment option in PD patients with high peritoneal transport rates, in patients with inadequate small-solute clearances during continuous ambulatory peritoneal dialysis (CAPD) treatment, and in patients with complications associated with high intraperitoneal pressure. Because APD offers better flexibility during the daytime, patients often have a better quality of life and are able to go to work or school. However, APD is more expensive and technically more complex than CAPD and there are controversial results on the course of residual renal function and the risk of peritonitis in the two types of treatment. The increased elimination of antibiotic drugs during cycler therapy has to be considered in patients with peritonitis, especially in those using high treatment volumes. When used during the daytime dwell, polyglucose solution has been shown to improve ultrafiltration and reduce the extracellular fluid volume in PD patients. In comparison with conventional dialysis solutions, treatment with pH-neutral solutions allows better correction of metabolic acidosis and is associated with an increase of CA-125 dialysate concentrations and a reduction of infusion pain. Tidal PD has its place in patients with mechanical outflow problems; however, compared with conventional APD, there is no improvement of clearances when the dialysate flow is kept constant. Continuous-flow PD using a double-lumen catheter is more effective but also more expensive than conventional APD. Most studies report a similar or even better patient survival with APD than with CAPD; however, a selection bias cannot be excluded from these mainly retrospective studies. In summary, APD is an established method of PD treatment that provides several advantages to patients and contributes to decreased technical drop-out rates.
Vychytil
Andreas
A
Abteilung für Nephrologie und Dialyse, Klinik für Innere Medizin III, Medizinische Universität Wien, Wien, Austria. andreas.vychytil@meduniwien.ac.at
D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010530:Peritoneal Dialysis / Q000295:instrumentation* / Q000379:methods* / Q000639:trends; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D013673:Technology Assessment, Biomedical; D013813:Therapy, Computer-Assisted / Q000295:instrumentation* / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome