Adapted APD

The adapted automated PD (aAPD) approach was proposed by Fischbach M. et al.¹ By combining sequences of short dwells and small fill volumes with long dwells and large fill volumes, aAPD promotes ultrafiltration (UF) and clearance within one PD session. Compared with conventional APD, by targeting UF and clearance separately, aAPD increases dialysis efficiency with a reduction in glucose absorption.

Reaching adequacy targets in PD for both UF and clearance is challenging. Research suggests that shorter dwell times and smaller fill volumes promote the process of UF, while longer dwell times and large fill volumes increase solute clearance¹. In theory, the conventional PD technique with repetitive, identical exchanges makes it difficult to achieve the simultaneous optimization of these two targets within one PD session.

Fischbach M. et al¹. conducted a randomized, prospective, cross-over, multicenter study. 19 patients were included in the final analysis.

The study results provide evidence that compared with conventional APD, targeting UF vs. clearance separately, by varying dwell times and fill volumes, improves dialysis efficiency with a reduction in metabolic cost¹. 

• Increased UF
• Better sodium removal
• Lower blood pressure
• Optimized clearance: urea, creatinine, phosphate
• Reduced metabolic load

• Simple to formulate prescription
• Efficiently uses existing resources
• Potentially extends length of PD therapy