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