APD or CAPD: one glove does not fit all
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NEPHROLOGY - REVIEW
APD or CAPD: one glove does not fit all Athanasios Roumeliotis1 · Stefanos Roumeliotis1 · Konstantinos Leivaditis1 · Marios Salmas2 · Theodoros Eleftheriadis3 · Vassilios Liakopoulos1 Received: 12 July 2020 / Accepted: 3 October 2020 © Springer Nature B.V. 2020
Abstract The use of Automated Peritoneal Dialysis (APD) in its various forms has increased over the past few years mainly in developed countries. This could be attributed to improved cycler design, apparent lifestyle benefits and the ability to achieve adequacy and ultrafiltration targets. However, the dilemma of choosing the superior modality between APD and Continuous Ambulatory Peritoneal Dialysis (CAPD) has not yet been resolved. When it comes to fast transporters and assisted PD, APD is certainly considered the most suitable Peritoneal Dialysis (PD) modality. Improved patients’ compliance, lower intraperitoneal pressure and possibly lower incidence of peritonitis have been also associated with APD. However, concerns regarding increased cost, a more rapid decline in residual renal function, inadequate sodium removal and disturbed sleep are APD’s setbacks. Besides APD superiority over CAPD in fast transporters, the other medical advantages of APD still remain controversial. In any case, APD should be readily available for all patients starting PD and the most important indication for its implementation remains patient’s choice. Keywords Automated peritoneal dialysis (APD) · Continuous ambulatory peritoneal dialysis (CAPD) · Fast transporters · Patient selection
Introduction The implementation of various forms of Automated Peritoneal Dialysis (APD) has considerably increased over the past few years. This increase can be attributed to improved cycler design, apparent lifestyle advantages and the ability to achieve adequacy and ultrafiltration targets. According to the European Renal Association/European Dialysis and Transplant Association (ERA/EDTA) database, the use of APD in Europe showed a remarkable increase in 2016. In Greece, 65% of Peritoneal Dialysis (PD) patients were on APD. This percentage varied between 40 and 60% in most
* Vassilios Liakopoulos [email protected] 1
Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636 Thessaloníki, Greece
2
Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
3
Department of Nephrology, Medical School, University of Thessaly, Larissa, Greece
European countries [1]. In the United States (US), APD is the first choice for patients initiating PD since the late 90s. Considering the relatively steady overall implementation of PD, the proportion of APD has risen at the expense of Continuous Ambulatory PD (CAPD). According to the US Renal Data System (USRDS), the percentage of patients on APD has increased from 47% in 2000 to 80% in 2015, while over the same period the total PD proportion
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