ADVANTAGES AND DISADVANTAGES OF AUTOMATED PERITONEAL DIALYSIS COMPARED TO CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

I n many countries, automated peritoneal dialysis (APD) has grown dramatically in recent years and, at present, can be said to be the fastest growing mo dality of dialysis in the world. Thus, in 1997, it was estimated that about 28 000 PD patients, representing more than one quarter of the total worldwide, were being maintained on APD (Baxter Corporation. Personal communication). In the U.S., the percentage of PD patients on APD has risen from 12 % in 1992 to 32 % in 1996 (1) and, in Canada, from 9% in 1993 to 28 % in 1997 (Baxter Corporation. Personal communication). It is generally thought that this growth reflects a number of factors. One is the technological improvement in cyclers, which has made them more compact, attractive, and portable. Another is the increased emphasis on adequacy of PD (2) associated with the notion that greater clearances can be achieved on this modality than on traditional CAPD. A third is the perception that APD may have "lifestyle" advantages for many patients or for their relatives and caregivers. All of these factors raise the question of what the future roles for CAPD and APD will be. Should all PD patients be treated with APD or does CAPD have an ongoing role to play? Is APD an inherently superior modality? In this review, the relative advantages and disadvantages of the two modalities will be dis cussed under a number ofheadings, including lifestyle, clinical outcomes, and cost. LIFESTYLE ISSUES The obvious lifestyle advantage for APD as compared to standard CAPD is that it requires two rather than four procedures daily. This factor has long bee