Automated Peritoneal Dialysis: When and how to do it

Abstract

A utomated peritoneal dialysis (APD) is the fastest growing dialysis treatment in the world at the present time. The evolution of this peritoneal dialysis (PD) modality is closely linked to the development ofnew automatic machines and to recent advances in prescription and monitoring of PD treatment. Since 1960, machines have been introduced to perform semiautomatic or fully automatic PD treatment. In the early days, peritoneal dialysis was mostly intermittent (IPD), featuring a total of 24 hours per week divided into three or more sessions. The applied technology was similar to the hemodialysis machines of those years. The slow peritoneal transport of solutes limited the efficiency of the treatments (1). In recent years, knowledge derived from the equilibration dialysis concept of continuous ambulatory peritoneal dialysis (CAPD) and the availability of plastic bags (2) have contributed to a rediscovery of intermittent peritoneal dialysis techniques. APD has today become a daily home treatment with automated nightly exchanges and one or two daily dwells, following the concept of reversed CAPD (continuous cyclic PD: CCPD) (3,4). The development of ad hoc machines, easy to use and with a simpler operator interface (the cyclers) (1), represented a further key factor in this process of evolution. Another important step in APD is represented by microchips and computers. These components, incorporated into PD cyclers, gave the machines greater programming flexibility. Thanks to these innovations, it is now possible to prescribe individualized fill volumes, variable tidal volumes and additional daytime automated exchanges, teledialysis, and memorized delivery control. At the same time, miniaturization of