The significance of adequacy for success of an automated peritoneal dialysis program

: The dynamic development of APD causes the increasing importance of issues regarding the adequacy of this renal replacement therapy method. Basic parameters of effective dialysis are still Kt/V and weekly creatinine clearance. The lack of steady state of substance concentration in different body compartments is a potential cause of mistakes in calculation of APD adequacy kinetic parameters. The solute removal index (SRI) may be used as an alternative method of dialysis efficacy assessment. However, there is no "ideal" marker of adequacy. Therefore, it should be assessed on the base of analysis including kinetic, clinical and biochemical data. Residual renal function (RRF) is an important factor of successful APD, but there are different opinions concerning the influence of automatic dialysis on RRF preservation presented in literature. The characteristics of peritoneal transport is the basic criterion for the qualification of patients to APD program. Automated techniques are recommended for patients being high-average transporters and particularly high transporters. The evolution of APD creates new perspectives for adequacy assessment and improvement of dialysis efficacy. The performance of multicenter studies and usage of new parameters of adequate dialysis will be very important for the development of APD. The employment of alternative fluids, introduction of modernized catheters and construction of "intelligent cyclers" will create new possibilities for programming and monitoring of dialysis and improvement of patient's life quality.