Differentiating between peritoneal dialysis methods

Peritoneal dialysis can be performed in two ways—continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). In this video, from our Dialysis Essentials course, you'll discover the differences between these two types of dialysis, how they both work, and how to adjust dialysis prescriptions.

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Peritoneal dialysis can be performed two ways. Continuous ambulatory peritoneal dialysis or CIPD uses manual exchanges. Automated peritoneal dialysis or APD is performed overnight using an automated cycler. Continuous ambulatory peritoneal dialysis uses gravity to instill and drain fluid. One manual exchange, which means draining and instilling dialysis fluid takes 30 minutes.

A typical prescription might require three to six exchanges in a 24-hour period. These exchanges are usually done during the day and allow for a longer dwell at night about eight hours so the patient can sleep. The cycler is used in automated peritoneal dialysis, which is typically done only at night over eight to ten hours.

This takes all the day exchanges and does them at night with shorter times between the exchanges because it uses a pump to push dialysis fluid in and stuff the fluid out after is sat in the abdomen for a specific period of time. A common automated peritoneal dialysis prescription is for exchanges with two liter fills over eight to ten hours at night, so a total of eight liters per day.

With automated peritoneal dialysis, the abdomen can remain filled during the day with one to two manual exchanges or remain dry without any fluid. This will depend on the results of the peritoneal membrane test for individual patients. A typical prescription with both night and day exchanges would be for exchanges with two liter fills over eight to ten hours at night with a two liter day exchange so ten liters per day.

If the patient has significant residual kidney function, then they might need less dialysis such as fewer exchanges or lower volume. The peritoneal equilibration test will determine the salt transport type and will help with making adjustments to the prescription.