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Part 3: Clinical Experiences |
Department of Nephrology,1 Medical School, University of Thessaly, Larissa, and Peritoneal Dialysis Unit,2 1st Department of Internal Medicine, AHEPA Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Correspondence to: N. Dombros, 32 Ethnikis Aminis Street, Thessaloniki 54621 Greece. dombros{at}auth.gr
The use of the various forms of automated peritoneal dialysis (APD) has
increased considerably in the past few years. This increase has in part been
driven by technology, through improved cycler design. Other contributing
factors include better adjustment of APD to patient lifestyle, the flexibility
that APD offers to patients, and the increased ability of APD to achieve
adequacy and ultrafiltration targets. For high transporters and for patients
unable to perform peritoneal dialysis (PD) on their own (for example,
pediatric and elderly patients), APD is considered the most suitable PD
modality. Furthermore, APD has been associated with improved compliance, lower
intraperitoneal pressure, and lower incidences of peritonitis. On the other
hand, concerns have been raised regarding increased complexity and cost, a
more rapid decline in residual renal function, inadequate sodium removal, and
disturbed sleep. Automated PD is an alternative to continuous ambulatory PD
when a higher dialysis dose is needed, and it could be a reliable alternative
for unplanned or urgent dialysis start. Other than beneficial results in high
transporters, the medical advantages of APD remain controversial. Individual
patient choice therefore remains the main indication for the application of
APD, which should be made available to all patients starting PD.
KEY WORDS: APD; high transporters; indications; patient preference; patient selection.
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