Breakthrough in Automated Peritoneal Dialysis (APD)

 
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Scientific symposium demonstrated improved treatment efficiency with aAPD

Well-known international Key Opinion Leader, Prof Michel Fischbach from France, displayed latest study data on adapted Automated Peritoneal Dialysis (aAPD) highlighting advantages of this therapy modality.

 

A scientific symposium focusing on adapted Automated Peritoneal Dialysis (aAPD) was held in Singapore in late September. Presented by well-known international Key Opinion Leader, Professor Michel Fischbach from France, the symposium was organised by Fresenius Medical Care Singapore under the auspices of the Singapore Society of Nephrology (SSN).

The focus of the presentation was to demonstrate that whilst reaching adequacy targets in PD for both ultrafiltration (UF) and clearance is challenging, this new prescription, aAPD, shows impressive study results by combining sequences of short dwells and small fill volumes with long dwells and large fill volumes. aAPD promotes UF and clearance in one PD session. Compared with conventional APD, by targeting UF and clearance separately, aAPD increases dialysis efficiency with a reduction of glucose absorption.

The randomised controlled crossover trial with 25 patients resulted in a statistically significant improvement in clearances of urea, creatinine and phosphate along with a lower blood pressure and improved ultrafiltration, higher sodium removal and lower glucose reabsorption in patients on Adapted APD than patients on conventional APD using the same PD fluids, glucose concentration and total treatment time.1

Professor Fischbach, Chief of the Paediatric Department at the University Hospital of Strasbourg and Professor of Paediatrics at the University Louis Pasteur of Strasbourg, France identified that aAPD will benefit the patient in the following ways:

  • Significantly improved urea, creatinine and phosphate solute clearances
  • Increase in 24 hour ultrafiltration
  • Reduced glucose absorption
  • 90% increase in sodium removal leading to lower mean and systolic blood pressure.

The symposium was moderated by Dr. Foo Wai Yin, Marjorie MB ChB (Belfast), MRCP (UK), FRCP (Glas), FAMS, Senior Consultant, Department of Renal Medicine, SGH. 

The session concluded with an active Q&A session raising some interesting clinical questions. To obtain a full copy of the Q&A’s, please contact us via the email address below.


MORE ON ADAPTED APD

Adapted APD is a new approach to peritoneal dialysis prescription in that it adapts automated peritoneal dialysis therapy (APD) by providing varying dwell times and dwell volumes in order to favour dialysis efficiency and overall optimization of volume control.


APD Graph Online


The concept is based on having 2 short dwell times with smaller fill volumes which are designed to enhance ultrafiltration followed by 3-4 long dwell times with higher fill volumes to enhance solute clearance.

Although the short dwell exchanges ensure adequate ultrafiltration (UF) because the crystalloid osmotic gradient is maintained they are not adequate for clearances of solutes such as creatinine and phosphate that need a longer diffusion time than urea does. Regarding optimising the dwell time, a short dwell exchange should lead to greater UF capacity because the lower intra-peritoneal pressure promotes UF removal as well as decreasing the risk of glucose and subsequent fluid reabsorption. Conversely a larger intra-peritoneal fill volume ensures that the total peritoneal membrane area is recruited for dialysis; hence a larger amount of fluid is drained and greater solute clearance is achieved. The long dwell exchange should favour ‘saturation’ of the dialysate with creatinine and phosphate.

To view the abstract, click here.

To view the full article, click here.

 

References:

  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): a randomized controlled trial. Perit Dial Int 2011; Jul-Aug;31(4):450-8.