Automated Peritoneal Dialysis (APD)

Automated peritoneal dialysis (APD) is a home therapy option for end-stage kidney disease, performed using a dialysis machine, which helps to deliver and drain the dialysate automatically.

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Patient sleeping while performing Automated Peritoneal Dialysis using a cycler

What is Automated Peritoneal Dialysis (APD)?

Automated PD (APD) is a type of PD that is performed using a dialysis machine, which helps to deliver and drain the dialysate automatically, with minimal human intervention. This dialysis machine, also called a cycler, is programmed to provide the exact amount of dialysate prescribed by your clinician. An APD exchange typically takes between 8 and 12 hours and can be performed overnight while you sleep.

How does Automated Peritoneal Dialysis (APD) work?

Before each dialysis session, your APD cycler is connected to 10-15 liters of clean dialysis solution. A tube from the cycler is then connected to a catheter in your abdomen. The APD cycler is programmed to control the movement of clean dialysis solution into your abdomen by the machine.

It drains the used dialysis solution from your body and replaces it with fresh solution at regular intervals throughout the therapy duration. You will have to set up the dialysis machine with fresh equipment and dialysis fluid for each APD session. Every patient is different and your APD cycler’s program will be customized to your specific needs.

APD is an alternative to CAPD which employs a cycler machine to deliver dialysis fluid into the abdomen every night while the patient is asleep. Below are some reasons why APD may be a better choice for you:

Why do I need APD?

Lower chances of swelling due to excess fluid in your body¹

Ultrafiltration is the removal of fluid from the patient body, and it is one of the kidney functions that dialysis treatment replaces. Peritoneal dialysis (PD) uses ultrafiltration to remove fluid via the peritoneal membrane. APD can have a better ultrafiltration effect in some patients, allowing for more fluid to be removed during each exchange, thus reducing swelling due to excess fluid.

Potentially lower risk of peritonitis ¹

APD exchange is usually done overnight, therefore patients would only need to connect and disconnect their catheter to the APD machine once a day. Whereas, CAPD exchanges are usually done 3-4 times during the day, patients would then need to connect and disconnect their catheter to the dialysate bags multiple times a day, which can significantly increase their risk of infection.

Less discomfort²

CAPD exchanges are usually done with patients in a sitting position, while APD exchanges are usually done with patients in their lying position. Therefore, the pressure felt in your abdomen during APD could be 50% lower compared to CAPD.

Greater daytime flexibility²

As APD is performed during sleep, you can enjoy more flexibility during the day. In fact, over 60% of APD patients are employed full-time, so you can still support yourself and your family financially while on APD.

Despite having a lower risk of complications for APD patients, general PD complications may still arise, such as infection and hernia.

Learn more about PD’s complications and side effects

FAQ

How to prepare for Automated Peritoneal Dialysis (APD)?

As a portable dialysis machine will be placed in your home, there are a few requirements and preparations needed. You may contact your dialysis service provider if you require assistance.

Preparing your home environment

The APD cycler is designed to suit most households. The cycler will not take up much room space, but you will need some storage space for your APD supplies.

The APD cycler should be placed on a stable, clean and flat surface (e.g., a table or trolley) with two electrical outlets nearby for the operation of both the cycler and modem. The modem will allow the transmission of your dialysis treatment data to a cloud-based Remote Patient Management (RPM) platform so that your healthcare team can proactively identify potential complications and intervene early if required to avoid unplanned hospital or clinic visits.

A best practice is to ensure that the door and windows are closed, and the fan is switched off when connecting and disconnecting your PD catheter during APD. This helps to greatly lower the risk of potential infection.

How can Remote Patient Management (RPM) help Automated Peritoneal Dialysis (APD) patients?

If your APD cycler has Remote Patient Management (RPM) capabilities, it can collect accurate information about your home treatments daily and send it to your clinician. Your clinician can monitor your therapy progress, identify potential complications, intervene early, and change your machine programs remotely.

You can feel confident managing your treatment at home knowing that your clinician is able to track and adjust your treatment. You will still need to contact your clinician or cycler manufacturer to address urgent concerns during treatment.

Not all APD cyclers have RPM capabilities, so be sure to talk to your clinician about whether RPM fits into your treatment plan.

What is it like to live with Automated Peritoneal Dialysis (APD)?

APD treatment usually lasts between 8 and 12 hours, depending on your medical and lifestyle requirements. It is typically done while you sleep, giving you the freedom to carry on your normal activities during the day. APD may make it easier for you to continue working, studying, or socializing during the day. Additional daytime dialysis exchanges may sometimes be required; your clinician will advise you if this is necessary.

For the treatment to take place, you need to be connected to your APD cycler. However, it is possible to temporarily disconnect from the machine if necessary. There is also sometimes longer tubing that allows you more freedom to move around while you are connected to the machine. You will need to prepare your cycler each day and discard the used equipment after your treatment has finished.

APD helps control excess waste and fluid during treatment, which can help reduce the stress on your body. It may also provide you with increased flexibility with your diet and the number of medications you need to take while on dialysis.

How long can I live on Automated Peritoneal Dialysis (APD)?

Where to go next?

Illustration of patient reading while performing dialysis at home

Continuous Ambulatory Peritoneal Dialysis (CAPD)

CAPD can be performed at work, home or during travel.

Illustration of a patient participating in in-centre haemodialysis

In-Centre Haemodialysis (In-Centre HD)

You may prefer to receive dialysis at a hospital or treatment centre near you with ICHD.

other treatments for chronic kidney disease

Kidney Transplant & Conservative Care

If you and your clinician decide dialysis isn’t right for you, there are other treatment options you may consider.

References

Mehrotra R, Devuyst O, Davies SJ, Johnson DW. The current state of peritoneal dialysis. Journal of the American Society of Nephrology. 2016 Nov 1;27(11):3238-52
Roumeliotis A, Roumeliotis S, Leivaditis K, Salmas M, Eleftheriadis T, Liakopoulos V. APD or CAPD: one glove does not fit all. International Urology and Nephrology. 2021 Jun;53(6):1149-60
Sakacı T, Ahbap E, Koc Y, et al. Clinical outcomes and mortality in elderly peritoneal dialysis patients. Clinics (Sao Paulo). 2015;70(5):363-368. doi:10.6061/clinics/2015(05)10

Chronic Kidney Disease

Kidney Disease Treatment

Living with Dialysis

Automated Peritoneal Dialysis (APD)

What is Automated Peritoneal Dialysis (APD)?

How does Automated Peritoneal Dialysis (APD) work?

Why do I need APD?