Clinical Usefulness of Automated Peritoneal Dialysis (APD) in End Stage Renal Disease Patients

Yoo, Tae Hyun; Ryu, Dong Ryeol; Kim, Hyung Jong; Choi, Hoon Young; Kim, Joo Sung; Kang, Shin Wook; Choi, Kyu Hun; Han, Dae Suk; Lee, Ho Yung

Abstract

BACKGROUND
In many countries, APD is growing dialysis modality in ESRD patients, however, it is still unfamiliar in Korea. To evaluate the clinical usefulness of APD, we retrospectively analyzed the clinical and biochemical characteristics of APD patients in Yonsei University Medical Center (YUMC). METHODS: The incidence of CAPD (continuous ambulatory peritoneal dialysis) and APD in Korea was evaluated by PD solution companies (Baxter, FMC, Gambro, Boryung) in Korea. Clinical and biochemical data were collected from 96 subjects who have been maintained on APD at least more than 1 month from January 1996 to Jan. 2004 in YUMC. Peritoneal equilibration test (PET) was done within 3 months after initiation of CAPD and APD, respectively. Kt/V urea was also evaluated. We compared the factors of APD maintenance between early termination group and maintenance group. The maintenance group was defined as those patients who could be treated more than 6 month by APD. RESULTS: The mean age of the patients was 51.6+/-14.6 years with sex ratio (M: F) 45: 51, and mean duration of dialysis was 25.3+/-28.2 months. The causes of conversion from CAPD to APD were inadequate dialysis, ultrafiltration failure, and patient preference, etc. As urea kinetics was analyzed during CAPD or APD, there was no difference in total Kt/Vurea, but significant difference in renal Kt/ Vurea and dialysis Kt/Vurea between CAPD and APD. Incidence of PD peritonitis was significantly lower in APD group compared to CAPD group. There was no difference in the incidence of exit site infection. APD was stopped from kidney transplantation, death, peritonitis, and patient refuse. Only 11 cases were not solved the problems even after the conversion to APD. In maintenance group, duration of dialysis was shorter than the early termination group and serum albumin was significantly higher at 6 month after APD. CONCLUSION: APD has been rapidly expanding the territory in Korean ESRD patients. In CAPD patients with inadequate dialysis dose and ultrafiltration failure, APD is good alternatives for the maintenance to peritoneal dialysis modality.