Experience with intermittent peritoneal dialysis and continuous cyclic peritoneal dialysis

Acceptance of peritoneal dialysis as a standard modality of therapy for end-stage renal disease (ESRD) was initially slow due to various technical problems and the difficulty of quantitating peritoneal membrane function. Development of reliable, permanent access to the peritoneum and the availability of dependable automated equipment stimulated the development of intermittent peritoneal dialysis (IPD), which demonstrated initial success. However, the failure rate was noted to increase with time, primarily due to insufficient dialysis and malnutrition. The introduction of continuous ambulatory peritoneal dialysis (CAPD) allowed better clearances and the maintenance of a more physiologic steady state. However, the twin problems of inconvenience and frequent infections proved to be significant. Continuous cyclic peritoneal dialysis (CCPD) was then developed to allow exchanges at night on a more convenient basis, reduce the rate of peritonitis by circumventing some of the technical disadvantages of CAPD, and decrease the stress on any helpers who may be involved. Experience with CCPD has demonstrated acceptable control of nitrogenous waste products, fluid balance, adequate maintenance of nutrition in the great majority of patients, and satisfactory maintenance of hemoglobin and acid-base balance. CCPD also offers flexibility of prescription accomplished by varying the frequency and length of nocturnal automated cycles. The preliminary experience with peritoneal kinetic modeling suggests that quantitation of peritoneal function will be significantly improved in the future and that standards of adequacy of dialysis will be more precisely defined.