APD Schedules and Clinical Results

Abstract

This chapter exposes the clinical effects of different APD schedules. Clinical studies have shown that Na removal is lower with APD compared to CAPD. Therefore the loss of residual renal function requires continuous therapy with long day-dwell of polyglucose dialysate. Peritoneal small molecule clearances are closely determined by the hourly dialysate flow rate (and not the dwell time, which is a concept coming from equilibrium PD techniques as CAPD) with a maximum reached by 3 l/h for average transporter patients. On the other hand, the optimal intraperitoneal volume should be 1500 ml/m(2) of BSA, and less if the hydrostatic intraperitoneal pressure is higher than 18 cm H(2)O. The optimization of the nocturnal APD session depends on the knowledge of the individual drain flow profile. A new schedule, called 'BreakPoint-APD' is based on the automatic adaptation to the drain profile for each patient and for each cycle. It increases clearances by about 10% compared to tidal and CCPD, though reducing the number of nocturnal alarms. The future of APD is likely to continue thanks to further simplification in the machine use, i.e. with improvements in cycler technology.

Peritoneal Residual Volume Induces Variability of Ultrafiltration with Icodextrin

“…Ultrafiltration was simulated using a modified three-pore model based on PD Adequest 2.0 (Baxter Healthcare Corporation) (14,24) with the use of 3.86% glucose and 7.5% icodextrin solutions during a 12-hour dwell in average-sized patients having high (or fast), high-average, low-average, and low (or slow) transport characteristics. Peritoneal V R was systematically varied from 150 mL to 1200 mL, representing the range previously reported (25).…”

Tidal continuous cycling peritoneal dialysis in children

“…The outflow of drained fluid during PD is biphasic; after an initial fast phase with constant rapid outflow, a slow phase abruptly ensues. This transition or ‘break point’ usually occurs after around 5 min after a 2-L dwell and adds to the total time on dialysis, without contributing to any substantive clearance [ 4 ]. This is further compounded in instances when the dialysate outflow rate is even slower than usual, as in settings of catheter malfunction or in patients with adhesions in the peritoneum; in such cases, the transition point is reached even earlier leading to suboptimal solute clearance.…”