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Adapted APD (aAPD)

Adapted APD visual

According to Fischbach et al, aAPD offers better results using the same time and resources1

  • aAPD is possible without extra fluids or a longer amount of time
  • Efficiently uses existing treatment resources: better ultrafiltration and clearance with same, low glucose concentration, fluid volume and treatment time compared to conventional APD (cAPD)

Attaining adequacy targets

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.

The challenges of PD — Reaching adequacy targets

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 study supports the effectivity of aAPD1

Fischbach M. et al.1 conducted a randomized, prospective, cross-over, multicenter study. 19 patients were included in the final analysis.

aAPD is possible without extra fluids or a longer amount of time, with the same glucose concentration

Figure 2: Modified cAPD graphic following Fischbach M. et al., 2011 (page 3)1

Figure 3: Modified aAPD graphic following Fischbach M. et al., 2011 (page 3)1

 

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.

Comparison after 45 days

Figure 4: figure created based on study data of Fischbach, M. et al., 2011 (page 7) comparing mean daily UF and sodium removal after 45 days, showing better UF (+100 ml/session) and sodium removal (+14 mmol/session) for aAPD1

Higher clearance with aAPD over glucose absorbed1

Figure 5: Modified graphic following Fischbach. et al., 2011 (page 6) indicating improved sodium removal and clearance for aAPD1

Summary of the results of the study by Fischbach et al.1

Patient benefits

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


Clinical value

  • Efficiently uses existing treatment resources: better ultrafiltration and clearance with same, low glucose concentration, fluid volume and treatment time compared to cAPD
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1 Fischbach M, Issad B, Dubois V, Taamma R. The beneficial influence on the effectiveness of automated peritoneal dialysis of varying the dwell time (short/long) and fill volume (small/large): randomized controlled trial. Peritoneal Dialysis International 2011; 31(4):450-8