Comparative outcomes between continuous ambulatory and automated peritoneal dialysis: a narrative review

Am J Kidney Dis. 2014 Jun;63(6):1027-37. doi: 10.1053/j.ajkd.2013.11.025. Epub 2014 Jan 11.


Automated methods for delivering peritoneal dialysis (PD) to persons with end-stage renal disease continue to gain popularity worldwide, particularly in developed countries. However, the endeavor to automate the PD process has not been advanced on the strength of high-level evidence for superiority of automated over manual methods. This article summarizes available studies that have shed light on the evidence that compares the association of treatment with continuous ambulatory PD or automated PD (APD) with clinically meaningful outcomes. Published evidence, primarily from observational studies, has been unable to demonstrate a consistent difference in residual kidney function loss rate, peritonitis rate, maintenance of euvolemia, technique survival, mortality, or health-related quality of life in individuals undergoing continuous ambulatory PD versus APD. At the same time, the future of APD technology appears ripe for further improvement, such as the incorporation of voice commands and expanded use of telemedicine. Given these considerations, it appears that patient choice should drive the decision about PD modality.

Keywords: End-stage renal disease (ESRD); automated peritoneal dialysis (APD); continuous ambulatory peritoneal dialysis (CAPD); health-related quality of life; mortality; peritoneal dialysis (PD); peritonitis; residual kidney function.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Equipment Design
  • Humans
  • Kidney Failure, Chronic / therapy
  • Peritoneal Dialysis / adverse effects
  • Peritoneal Dialysis / instrumentation
  • Peritoneal Dialysis / methods*
  • Peritoneal Dialysis / mortality
  • Peritoneal Dialysis, Continuous Ambulatory* / adverse effects
  • Peritoneal Dialysis, Continuous Ambulatory* / instrumentation
  • Peritoneal Dialysis, Continuous Ambulatory* / mortality
  • Peritonitis / etiology
  • Quality of Life
  • Telemedicine
  • Treatment Outcome