Adapted APD (aAPD)

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 and clearance within one PD session. The blood purification and ultrafiltration achieved for every gram of glucose absorbed was higher in aAPD in comparison to cAPD¹.

Reaching adequacy targets in PD for both ultrafiltration and clearance is challenging. Fischbach et al. propose that shorter dwell times and smaller fill volumes promote the process of ultrafiltration, while longer dwell times and large fill volumes increase solute clearance¹. The proposed strategy may have the potential to improve the 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 cAPD, targeting ultrafiltration vs. clearance separately, by varying dwell times and fill volumes, may improve dialysis adequacy with a reduction in metabolic burden¹.

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

• Efficiently uses existing treatment resources: better ultrafiltration and clearance with same, low glucose concentration, fluid volume and treatment time compared to cAPD