Indications and adequacy of automated peritoneal dialysis in 74 patients

Experience with chronic intermittent peritoneal dialysis is reviewed to focus on automated peritoneal dialysis (APD) regimens, adequacy and indications. From 1969 to 1990, 74 ESRD patients were treated: 59 patients with Intermittent Peritoneal Dialysis (IPD: 30-40 l x 3/week) and fifteen patients with hour Daily Peritoneal Dialysis (DPD: 25 l x 6 nights/week). Fourty-four patients were regularly treated with IPD. Of these 33 were adequately dialysed, maintaining residual renal function, whilst oligo-anuric patients developed underdialysis. DPD patients were adequately dialysed, having satisfactory peritoneal clearances. Peritonitis rate was 1/19.2 pt months in IPD patients and 1/13.4 pt months in DPD patients. Technique survival was 78% at the end of the first year, and 52% the second year. IPD is adequate only for low body weight patients with residual renal function. In-hospital IPD must be taken into account only for patients unable to perform dialysis without partner assistance. Home DPD, like CCPD and NPD, is generally adequate and yields fairly good quality of life, but the cost is high, probably because of limited ADP diffusion. Prescription must be therefore restricted to patients unable to perform dialysis with working partners, workers who cannot cope with CAPD exchanges, and CAPD failures.