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Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications01:25

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Practical guidelines for automated peritoneal dialysis.

Suchai Sritippayawan1, Sukij Nilwarangkur, Nipa Aiyasanon

  • 1Division of Nephrology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sritippayawan@gmail.com

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|November 3, 2011
PubMed
Summary
This summary is machine-generated.

Automated peritoneal dialysis (APD) offers customized dialysis, especially for patients with high transport or caregiver dependence. APD can reduce peritonitis rates compared to continuous ambulatory peritoneal dialysis (CAPD).

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Area of Science:

  • Nephrology
  • Renal Medicine
  • Dialysis Technology

Background:

  • Automated peritoneal dialysis (APD) allows for customized dialysis prescriptions.
  • APD can be used alone or with daytime dwells to increase dialysis dose.
  • APD is recommended for specific patient groups, including those with high peritoneal transport or outflow issues.

Purpose of the Study:

  • To evaluate the role and effectiveness of APD in optimizing peritoneal dialysis (PD).
  • To outline the considerations and prescription guidelines for initiating APD.
  • To compare clinical outcomes, such as peritonitis rates, between APD and CAPD.

Main Methods:

  • Evaluation of patient factors including medical, psychosocial, financial, catheter function, residual renal function (RRF), body surface area, and peritoneal transport characteristics.
  • Prescription guidelines for APD: 1,500 ml/m2 dwell volume, 2 hours/cycle, 5 cycles/session (10-15 L total volume, 10 hours/session).
  • Monitoring of intraperitoneal pressure (IPP) below 18 cmH2O, small solute clearances, ultrafiltration, and volume status.

Main Results:

  • APD prescription can be adjusted for anuric patients needing higher fill volumes (15-20 L) and specialized solutions.
  • Clinical outcomes and clearances are monitored to achieve target weekly Kt/V urea (≥1.7) and creatinine clearance (CCr) (≥45 L/1.73 m2) for low transporters.
  • Siriraj Hospital data shows APD patients experienced 1.5-3 times less peritonitis than CAPD patients, with most anuric patients meeting Kt/V targets using 10 L of NIPD.

Conclusions:

  • APD provides a flexible approach to peritoneal dialysis, adaptable to individual patient needs and transport characteristics.
  • Careful patient evaluation and monitoring are crucial for successful APD implementation and achieving optimal dialysis outcomes.
  • APD demonstrates a potential benefit in reducing peritonitis rates compared to CAPD, as observed in specific clinical settings.