Automated peritoneal dialysis (APD) is a home treatment that can also be carried out during the night. Ä¢¹½´«Ã½'s APD products include ²õ±ô±ð±ð±èÄ¢¹½´«Ã½¢s²¹´Ú±ð harmony, ²õ±ô±ð±ð±èÄ¢¹½´«Ã½¢s²¹´Ú±ð and SILENCIA.
Peritoneal dialysis Ä¢¹½´«Ã½“ an overview
Peritoneal Dialysis (PD) is aÌýpatient-centric therapy. Patient-centric approaches have been shown to empower patients, enhance their well-being, improve the quality of care, and add to health systemsÄ¢¹½´«Ã½™ sustainability.1ÌýIn 2020 world-wide around 413,000 patients suffering from End Stage Kidney Disease were treated with Peritoneal Dialysis (PD) with increasing numbers.2
In addition to being treated at home, offering PD to patients has different benefits:
- No need to establish vascular access (e.g. fistula or graft)3,4
- Dialysis at home offers patients independence and scheduling flexibilty
- Less time spent travelling to and in dialysis facilities5,6
- Organise oneÄ¢¹½´«Ã½™s life around dialysis and particularly ability to travel6
CAPD: Individual clinical solutions for tailoring your patientsÄ¢¹½´«Ã½™ therapy
In the area of Continuous Ambulatory Peritoneal dialysis (CAPD) our individual clinical solutions are designed for tailoring your patientsÄ¢¹½´«Ã½™ therapy. The CAPD treatmentÌý²õ³Ù²¹²âÄ¢¹½´«Ã½¢s²¹´Ú±ðÌýsystem contains the safety features DISC and PIN, which are connected with the PD fluids. °Õ³ó±ðÌý²õ³Ù²¹²âÄ¢¹½´«Ã½¢s²¹´Ú±ðÌýsystem Ä¢¹½´«Ã½“ small details that make a big difference.
The prescribing information for Peritoneal Dialysis solutions can be viewedÌýhere.
PVC-free and free from harmful plasticizers
APD: Personalized treatment and adaptable over time
As individual as your patients:Ìý²õ±ô±ð±ð±èÄ¢¹½´«Ã½¢s²¹´Ú±ð harmony
How can one cycler offer therapy options tailored to your patientsÄ¢¹½´«Ã½™ needs?
In a small usability study from Reitz et al. theÌý²õ±ô±ð±ð±èÄ¢¹½´«Ã½¢s²¹´Ú±ðÌýharmony cycler demonstrated good learnability and ease of use.9
Adapted APD (aAPD) therapy withÌý²õ±ô±ð±ð±èÄ¢¹½´«Ã½¢s²¹´Ú±ðÌýharmonyÌýenables you to combine sequences of short dwells and small fill volumes with long dwells and large fill volumes and varying glucose concentrations. This way of prescribing PD, proposed by Fischbach et al., in comparison to CAPD, may have the potential to improve ultrafiltration (UF) as well as clearance of phosphate, and sodium, within one PD session.10
Ìý
²õ±ô±ð±ð±èÄ¢¹½´«Ã½¢s²¹´Ú±ð harmonyÌýoffers:
- Personalised treatment which is adjusted to your patientsÄ¢¹½´«Ã½™ needs. Treatment flexibility options with integrated FlexPoint technology
- Adapted APD therapy option which has been reported to improve ultrafiltration as well as clearance of urea, creatinine, phosphate, and sodium10,11ÌýÌý
- Integrated on-screen animations giving guidance and facilitating setup12
- Guided prescription on the cycler and viaÌýPatientOnLine softwareÌýsupporting therapy management (must be purchased separately)Ìý
Diverse training support for PD
Getting started with CAPD
We support you with a range of specific trainings that lay the foundation for a confident start to therapy. And while everybody is preparing, we help to make sure that everything is up and running in your patientsÄ¢¹½´«Ã½™ homes.
Individualisation of PD with fluid management
One of the major problems in todayÄ¢¹½´«Ã½™s practice of renal replacement therapy is the quantitative assessment and management of fluid status. There are many factors known to affect fluid status such as comorbid conditions, medication, nutrition and treatment modalities.13,14
The treatment of fluid imbalance in dialysis patients is important because of its role in the development of cardiovascular (CV) diseases, which represent the leading cause of death in dialysis patients.15ÌýAchieving euvolemia is hence a major goal in PD as both dehydration and overhydration can increase mortality through cardiovascular risk and impairment of residual kidney function (RRF).14,16
Important factors to consider in fluid status:
- UF alone can be misleading in evaluating patientsÄ¢¹½´«Ã½™ fluid status.
- To improve a patientÄ¢¹½´«Ã½™s fluid volume status, both the inflow and outflow should be controlled.
- Blood pressure can be a misleading parameter to evaluate fluid status and can prompt false therapy decisions.
ISPD guidelines/ recommendations Ä¢¹½´«Ã½“ Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis
ISPD guidelines suggest that clinicalÌý assessment should include a diverse spectrum of clinical and laboratory results, including peritoneal and renal clearances,Ìýhydration status, appetite and nutritional status, energy level, hemoglobin concentration, responsiveness to erythropoietin therapy, electrolytes and acidÄ¢¹½´«Ã½“base balance, calcium phosphate homeostasis, and blood pressure control (Evidence level C).19
Fluid overload is triggered by the expansion of the extracellular water.ÌýWhen examining fluid overload, it is important to divide total body water (TBW) into intracellular (ICW) and extracellular water (ECW). The latter is further divided into circulating and interstitial compartments.20,21
A step-by-step approach
A potential threat to the lives of Peritoneal Dialysis (PD) patients: fluid overload
Fluid management in peritoneal dialysis (PD) patients is highly important because it has been shown that:
- Fluid overloaded PD patients have a significantly higher mortality risk than euvolemic patients.16
Volume control Ä¢¹½´«Ã½“ Three steps for better volume control
This step-by-step approach is designed to support your PD patients. Based on our experience and diverse portfolio, we provide solutions for every step of fluid management. Our products and services cover the entire process and offer the chance for improved patient outcome.
The three steps consist of:
Obtain a better understanding of actual fluid status and trend
| Dehydration | Normohydration | Overhydration |
|---|---|---|
| Hypotension | Normotension | Hypertension |
| Loss of RRF | Preservation of RRF / Reduction of CV risk | Loss of RRF / LVH |
| Increased mortality | Improved survival | Increased mortality |
Ìý
Volume status improvement as a result of awareness
Use the awareness for better intake control
Preserve Residual Kidney Function (RKF) longer and use the adapted PD prescription concept
Improving fluid output in PD patients
The contribution of the kidney
The decline of RKF impacts clinical outcomes. Loss of RKF not only triggers fluid overload, but also contributes to inflammation, anemia, malnutrition, LVH, hypertension and cardiovascular disease.28
The contribution of the technique
With the decrease of RKF in chronic kidney disease, ultrafiltration (UF) via PD becomes more important and challenging. PD allows an individualized dialysis prescription by combining different techniques, dialysis solutions and number and duration of dwells.17
In view of the importance of RKF and UF for successful fluid management, clinical strategies to preserving RKF and to improve UF are of paramount importance.
Maintain RKF and UF capacity to expandÌýoutput
RKF is important for fluid and solute removal.ÌýMaintaining RKF is important for urine output and regulation of fluid status, thus using PD fluids may be an important contributor to your patient's fluid management.29
According to guidelines, it is recommended to use PD fluids that help to reduce the deleterious effects of chronic exposure to the peritoneal membrane and to preserve the membrane function longer.30,31,32
Important factors to consider in fluid status:
- UF alone can be misleading in evaluating patients' fluid status
- Fluid status is mainly the result of the balance of intake and output over time. To imporove a patient's fluid status, both sides should be controlled in order to determine the fluid status trend13
- BloodÌýpressure can be a misleading parameter to evaluate fluid status and can prompt false therapy decisions13
Adverse Events Reporting
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellowcard in the Google Play or Apple App Store. Adverse events should also be reported to Ä¢¹½´«Ã½ on 01623 445215 or VigilanceUK@freseniusmedicalcare.com.Ìý
UK-All-000020. Date of Preparation: June 2026.
Related content
1ÌýEuropean Commission, Communication from the Commission to the European Parliament, The Council, The European Economic and Social Committee and the Committee of the Regions on enabling the digital transformation of health and care in the Digital Single Market 2018
2ÌýÄ¢¹½´«Ã½, Annual Report 2020
3ÌýChan CT et al. Am J Kidney Dis 2019; 73(3):363-371
4ÌýAuguste BL et al. Can J Kidney Health Dis 2019
5ÌýSuri RS et al. Kidney Int. 2015; 88(2):360-8
6ÌýArgilés A et al. Nephrology Dialysis Transplantation 2020; 35(11):1863-1839
7ÌýKumar VA et al. Kidney Int 2014; 86(5):1016-1022
8ÌýÄ¢¹½´«Ã½, www.freseniusmedicalcare.asia/en/healthcare-professionals/home-therapies/staysafe-and-biofine/; 03/2022
9ÌýReitz T et al. Renal Replacement Therapy 2021; 7(20)
10ÌýFischbach M et al. Perit Dial Int 2011; 31(4):450-458
11ÌýVera M et al. PLoS One 2021; 16(12)
12ÌýPunzalan S et al. Journal of Kidney Care 2017; 2(5):262-267
13ÌýRonco C et al. Contrib Nephrol 2012;178:164-168
14ÌýYong-Lim K et al. Seminars in Nephrol 2017; 37(1):43-53
15ÌýShu Y et al. Blood Purif 2018; 46(4):350-358
16ÌýJotterand Drepper V et al. PLoS One 2016; 11(7):e0158741
17ÌýVan Biesen W et al. Clin J Am Soc Nephrol 2019; 14(6): 882-893
18ÌýRonco C et al. Nephrol Dial Transplant 2015; 30(5):849-858
19ÌýLo Wk et al. Perit Dial Int 2006; 26(5):520-522
20ÌýKim YL et al. Semin Nephrol 2017; 37(1):43-53
21ÌýChan et al. Eur J Comp Anim Pract 2014; 24:14-23
22ÌýCader RA et al. J Clin Nurs 2013; 22:741-748
23ÌýWang AY et al. Perit Dialysis Int 2015; 35:379-387
24ÌýLuo YJ et al. Blood Purif 2011; 31:296-302
25ÌýWilson J et al. Semin Dial 2014; 17(4):260-4
26ÌýAhmad S et al. Semin Dial 2004; 17(4):284-7
27ÌýGriva K et al. PLoS One 2014; 25;9(2):e8900
28ÌýMarron B et al. Kidney Int Suppl 2008; 108:42-51
29ÌýXin L et al. Center for Kidney Diseases Nanjing Medical University 2016
30ÌýWilliams JD et al. Kidney Int 2004; 66(1):408-18
31ÌýWeiss L et al. Perit Dial Int 2009; 29(6):630-633
32ÌýRippe B et al. Kidney Int 2001; 59(1):348-57