Adapted automated peritoneal dialysis.

Abstract

Conventional automated peritoneal dialysis (APD) is prescribed as a repetition of the same dwell time and the same fill volume delivered by the cycler during the dialysis session. Nevertheless, it is well recognized that a cycle with a short dwell time and a small fill volume favors ultrafiltration (UF), while a cycle with a long dwell time and a large fill volume favors uremic toxin removal. The use of varied dwell times and dwell volumes, called adapted APD, allows for an optimized peritoneal dialysis prescription with better volume control--that is, both an increased UF volume at a lower metabolic cost [UF per gram of glucose absorbed (mL/g)] and increased dialytic sodium removal resulting in improved removal of uremic toxins (urea, creatinine, phosphate) during dialysis.