Why use Baxter (Peritoneal Dialysis System) APD (Automated Peritoneal Dialysis) over Sleep-Safe APD for patients with Impaired Renal Function?

Choosing Between Baxter APD and Sleep-Safe APD Systems for Peritoneal Dialysis

The choice between Baxter APD and Sleep-Safe APD should be based primarily on patient quality of life considerations, as there is no high-level evidence demonstrating superior clinical outcomes with either system. 1, 2

Patient-Centered Factors to Consider

• APD systems in general offer better flexibility during daytime hours compared to CAPD, allowing patients to maintain employment and education commitments, which significantly improves quality of life 3
• Sleep-Safe APD may offer advantages in user interface and programming options, but the clinical significance of these differences has not been demonstrated in randomized controlled trials 2
• Patient preference should be a major determinant in selecting PD modality and equipment, as adherence to the prescribed regimen is critical for achieving adequate dialysis 1

Clinical Considerations

• Both systems can effectively deliver adequate dialysis as measured by Kt/V targets when properly prescribed 2

• APD in general (regardless of manufacturer) has several potential advantages over CAPD:

  • Lower incidence of peritonitis in some studies 4, 3
  • Better small solute clearances in certain patient populations 4
  • Reduced incidence of hernias due to less time spent with fluid in the abdomen 4
  • Particularly beneficial for high transporters who require shorter dwell times 2, 3

• Sleep disorders are common in all dialysis modalities, with APD patients showing higher rates of restless leg syndrome (50%) compared to HD (23%) or CAPD (33%) 5

Middle-Molecule Clearance Considerations

• Middle-molecule clearance is time-dependent in PD and not significantly influenced by dialysate flow rates or dwell volumes 1
• APD prescriptions with dry days (no daytime dwells) may compromise middle-molecule clearance, especially in patients with minimal residual kidney function 1
• For patients with minimal residual kidney function, the PD prescription should include dwells for the majority of the 24-hour day, regardless of which APD system is used 1

Special Patient Populations

• For patients who need rapid initiation of PD, APD may better preserve residual renal function compared to temporary hemodialysis (0.03 vs 0.06 mL/min/w decline rate) 6
• Large patients or those with inadequate small-solute clearances on CAPD may benefit from APD regardless of manufacturer 3
• Patients with high peritoneal transport rates generally do better with APD systems that can provide shorter, more frequent exchanges 2, 3

Practical Implementation

• Both systems require proper training for patients to ensure correct operation and adherence 2
• The tracking of treatment parameters (dwell times, fill volumes, drain volumes) is essential for monitoring dialysis adequacy with either system 2
• Proper aseptic technique during connection and disconnection procedures is critical for preventing peritonitis regardless of which system is used 2

Pitfalls and Caveats

• APD is generally more expensive than CAPD (approximately 20% higher direct costs), which may be a consideration in resource-limited settings 4
• APD is technically more complex than CAPD, which may present challenges for some patients 3
• There are conflicting results regarding the impact of APD on residual renal function preservation compared to CAPD 4, 3
• Increased elimination of antibiotics during cycler therapy must be considered when treating peritonitis in patients using either APD system 3