Medihub - Medical Information - Renal Medicine - Automated Peritoneal Dialysis: Dialysis At Home While You Sleep

Continuous ambulatory peritoneal dialysis (CAPD) can provide adequate dialysis to patients with good clinical outcomes that match that of hemodialysis. However, the multiple exchanges that need to be done on a daily basis through the day can sometimes tire a patient and his helper.

Automated peritoneal dialysis (APD) is a variation of peritoneal dialysis. Automated peritoneal dialysis is done at night by a machine while the patient is asleep. This removes the need for daily multiple exchanges during the day. A machine is used to automatically deliver the dialysates into the patients' abdomen through the peritoneal catheter.

The patient places a machine by his bedside. Before he sleeps, he attaches the catheter to a special 10-L dialysate bag, and then sets the machine. The machine controls the flow of dialysate into the abdomen. Usually this is done over 9 to 10 hours, over 4 cycles. At each cycle, up to 2.5 litres of dialysate is delivered into the abdomen and it dwells within the patient for about 2 to 3 hours each cycle.

The machine automatically drains the abdomen and refills it with a fresh dialysate. The cycle is repeated 4 times through the night. When the patient wakes in the morning, he disconnects himself from the machine. Most patients will continue to leave 2 litres of fluid in the abdomen for a long day dwell, until they sleep again at night and the cycle is repeated.

Differing machine models are available but most are small enough to fit a bedside desk, and operate quietly enough so as not to disturb the patient during the night. This form of dialysis relieves patients of having to interrupt their schedule during the course of the day. It also has the advantages of an even lower incidence of peritonitis.

APD has both medical and social advantages. To begin with, APD involves multiple nighttime exchanges that are automated. APD frees a person from the need for daytime exchanges and allows a patient more time during his waking hours.

Current APD machines are small and can be conveniently placed and moved about within the house, allowing more time for a patient to spend at home with his family. Some patients can even travel with the machine and continue to have APD; alternatively, they have the versatility of converting to CAPD when they need to. APD also provides more options for the doctor to adjust the dialysis therapy to suit the individual patients compared to regular CAPD.

While most patients will benefit from the therapy, some patients may not. Treatment needs to be individualized to the patient. It is preferable that a patient can stay on his machine continuously for the time prescribed, as APD does require a person to be hooked on a machine for 8 to 10 hours overnight.

Probably the strongest reason for a person not being able to do APD is that they cannot in any way tolerate being attached to a machine. Your physician is the best person to advise you on how suitable this form of dialysis will be for you