The role of automated peritoneal dialysis (APD) in an integrated dialysis programme.

While there is no doubt that renal transplantation would be the preferred option for all patients suffering from end stage renal disease, this is sadly an unrealistic aim for many patients in the UK. There is a shortage of donor organs and, with the increasing percentage of elderly patients on dialysis, under 50% of all dialysis patients are on the national transplant waiting list. Of the 12,000 or so patients on dialysis in the UK, approximately half receive haemodialysis and half peritoneal dialysis. In the last few years, there has been a resurgence of interest in automated peritoneal dialysis and just under 20% of the peritoneal dialysis population currently receive this mode of therapy. The advantages of automated peritoneal dialysis include the capacity for an increased dialysis prescription, increased freedom and quality of life and a decreased risk of peritonitis and intra peritoneal pressure related problems. These advantages may offset the increased cost of automated peritoneal dialysis and long-term patient morbidity and mortality may be diminished by its provision in an integrated dialysis programme.