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Adapted APD

Attaining adequacy targets

The adapted automated PD (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 (UF) and clearance within one PD session. Compared with conventional APD, by targeting UF and clearance separately, aAPD increases dialysis efficiency with a reduction in glucose absorption.

The challenges of PD — Reaching adequacy targets

Reaching adequacy targets in PD for both UF and clearance is challenging. Research suggests that shorter dwell times and smaller fill volumes promote the process of UF, while longer dwell times and large fill volumes increase solute clearance.1 In theory, the conventional PD technique with repetitive, identical exchanges makes it difficult to achieve the simultaneous optimization of these two targets within one PD session.

Study results support the efficiency of aAPD

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

conventional apd
adapted apd

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

The study results provide evidence that compared with conventional APD, targeting UF vs. clearance separately, by varying dwell times and fill volumes, improves dialysis efficiency with a reduction in metabolic cost.1

Comparison after 45 days

Higher mean ultrafiltration


Better sodium removal


Significantly higher clearance with adapted APD over glucose absorbed

45 days chart ultrafiltration

Patient benefits

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

Clinical value

  • Simple to formulate prescription
  • Efficiently uses existing resources
  • Potentially extends length of PD therapy

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