Automated Peritoneal Dialysis Versus Continuous Ambulatory Peritoneal Dialysis For People With Kidney Failure: A Review
Keywords:
Peritoneal Dialysis, Automated Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, Chronic Kidney Disease Stage V, Quality of Life
Abstract
Background: Peritoneal dialysis is a well-established renal replacement therapy for patients with end-stage kidney disease, offering two primary modalities: Automated Peritoneal Dialysis (APD) and Continuous Ambulatory Peritoneal Dialysis (CAPD). Both methods provide effective solute and fluid removal, cost-effectiveness, accessibility, and impact on patient lifestyle that vary significantly, particularly in resource-limited settings such as Indonesia.
Objective: This review compares APD and CAPD in terms of efficacy, convenience, cost-effectiveness, and accessibility, with a focus on their implications for patient care in Indonesia.
Methods: A systematic review of relevant literature was conducted to evaluate the benefits and limitations of both dialysis modalities. Factors such as treatment outcomes, cost, infection risk, insurance coverage, and availability were analyzed to determine the most suitable option for different patient populations.
Results: APD offers greater convenience, improved quality of life, and a lower risk of peritonitis due to fewer disconnections. However, its higher cost, dependency on electricity, and limited insurance coverage reduce its accessibility. Conversely, CAPD is more cost-effective, widely available, and covered by BPJS Kesehatan, making it the preferred option for many patients. Despite its affordability, CAPD requires greater patient commitment, increases peritonitis risk, and may interfere with daily activities.
Conclusions: Both APD and CAPD are effective dialysis options, but CAPD remains the more accessible and cost-effective choice in Indonesia. APD may benefit select populations if economic and infrastructural challenges are addressed. Expanding insurance coverage, reducing equipment costs, and improving infrastructure are crucial to increasing APD accessibility and optimizing dialysis care in Indonesia.
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References
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26. Chuasuwan A, Pooripussarakul S, Thakkinstian A, Ingsathit A, Pattanaprateep O. Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. Heal Qual Life Outcomes. 2020;18:1–11. doi:10.1186/s12955-020-01449-2
27. Peso G Del, Bajo MA, Costero O, Hevia C, Gil F, Díaz C, et al. Risk factors for abdominal wall complications in peritoneal dialysis patients. Perit Dial Int. 2003;23(3):249–254. doi:10.1177/089686080302300306
28. Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, V PJ, Wilkie M, et al. Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update. Perit Dial Int. 2019;39(5):414–36. doi:10.3747/pdi.2018.00232
29. Zhang Q, Wu P, Xie J, Li X, Xu T, Huang X, et al. Rapid initiation of peritoneal dialysis by automated peritoneal dialysis or hemodialysis: A randomized clinical trial. Kidney Dis. 2023;9(6):529–37. doi:10.1159/000534334
30. Cho Y, Bello AK, Levin A, Lunney M, Osman MA, Ye F, et al. Peritoneal dialysis use and practice patterns: An international survey study. Am J Kidney Dis. 2021;77(3):315–25. doi:10.1053/j.ajkd.2020.05.032
31. Teitelbaum I. Peritoneal dialysis. N Engl J Med. 2021;385(19):1786–95. doi:10.1056/nejmra2100152
32. Balda S, Power A, Papalois V, Brown E. Impact of hernias on peritoneal dialysis technique survival and residual renal function. Perit Dial Int. 2013;33(6):629–634. doi:10.3747/pdi.2012.00255
33. Flythe JE, Watnick S. Dialysis for chronic kidney failure: A review. JAMA. 2024;332(18):1559–73. doi:10.1001/jama.2024.16338
34. Prakash J, Singh LS, Shreeniwas S, Ghosh B, Singh T. Non-infectious complications of continuous ambulatory peritoneal dialysis and their impact on technique survival. Indian J Nephrol. 2011;21(2):112–5. doi:10.4103/0971-4065.82125
35. Morris PJ. Kidney transplantation - principles and practice. 2020. 1–768 p. doi:10.1016/c2016-0-01606-6
36. Giles HE, Parameswaran V, Lasky R. Trends in automated peritoneal dialysis prescriptions in a large dialysis organization in the United States. Clin J Am Soc Nephrol. 2024;19(6):723–731. doi:10.2215/cjn.0000000000000436
2. Vries JC de, Gelder MK van, Cappelli G, Rubio MAB, Verhaar MC, Gerritsen KGF. Evidence on continuous flow peritoneal dialysis: A review. Semin Dial. 2022;35(6):481–97. doi:10.1111/sdi.13097
3. Andreoli MCC, Totoli C. Peritoneal dialysis. Rev Assoc Med Bras. 2020;66(Suppl 1):37–44. doi:10.1590/1806-9282.66.s1.37
4. Negoi D, Khanna R. History of peritoneal dialysis. In: Nolph and Gokal’s Textbook of Peritoneal Dialysis. 2020. p. 1–26.
5. Putri S, Nugraha RR, Pujiyanti E, Thabrany H, Hasnur H, Istanti ND, et al. Supporting dialysis policy for end stage renal disease (ESRD) in Indonesia: an updated cost-effectiveness model. BMC Res Notes. 2022;15(1):1–6. doi:10.1186/s13104-022-06252-4
6. Wang IK, Yu TM, Yen TH, Lin SY, Chang CL, Lai PC, et al. Comparison of patient survival and technique survival between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Perit Dial Int. 2020;40(6):563–72. doi:10.1177/0896860820942987
7. Driehuis E, Eshuis M, Abrahams A, François K, Vernooij RWM. Automated peritoneal dialysis versus continuous ambulatory peritoneal dialysis for people with kidney failure. Cochrane Database Syst Rev. 2024;9(9):CD006515. doi:10.1002/14651858.cd006515.pub2
8. Bello AK, Okpechi IG, Osman MA, Cho Y, Cullis B, Htay H, et al. Epidemiology of peritoneal dialysis outcomes. Nat Rev Nephrol. 2022;18(12):779–93. doi:10.1038/s41581-022-00623-7
9. Yang F, Luo N, Lau T, Yu ZL, Foo MWY, Griva K. Health-related quality of life in patients treated with continuous ambulatory peritoneal dialysis and automated peritoneal dialysis in Singapore. Pharmacoecon Open. 2018;2(2):203–8. doi:10.1007/s41669-017-0046-z
10. Morelle J, Lambie M, Öberg CM, Davies S. The peritoneal membrane and its role in peritoneal dialysis. Clin J. 2024;19(2):244–53. doi:10.2215/cjn.0000000000000282
11. Tjahjodjati T, Kuddah Y, Wijayanti Z. Continuous ambulatory peritoneal dialysis cost-effectiveness in national health insurance era of Indonesia. Maj Kedokt Bandung. 2023;55(4):260–3. doi:10.15395/mkb.v55n4.2372
12. Lin T, Xia X, Yu J, Qiu Y, Yi C, Lin J, et al. The predictive study of the relation between elevated low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and mortality in peritoneal dialysis. Lipids Heal Dis. 2020;19(1):51. doi:10.1186/s12944-020-01240-8
13. Li X, Xu H, Chen N, Ni Z, Chen M, Chen L, et al. The effect of automated versus continuous ambulatory peritoneal dialysis on mortality risk in China. Perit Dial Int. 2018;38(Suppl 2):S25–35. doi:10.3747/pdi.2017.00235
14. Hamada C, Tomino Y. Recent understanding of peritoneal pathology in peritoneal dialysis patients in Japan. Blood Purif. 2021;50(6):719–28. doi:10.1159/000510282
15. Zhong Z, Peng F, Shi D, Peng Y, Li B, Xiao M, et al. Serum lipoprotein(a) and risk of mortality in patients on peritoneal dialysis. J Clin Lipidol. 2020;14(2):252–9. doi:10.1016/j.jacl.2020.01.008
16. Roumeliotis S, Dounousi E, Salmas M, Eleftheriadis T, Liakopoulos V. Unfavorable effects of peritoneal dialysis solutions on the peritoneal membrane: the role of oxidative stress. Biomolecules. 2020;10(5):768. doi:10.3390/biom10050768
17. Kunin M, Beckerman P. The peritoneal membrane—a potential mediator of fibrosis and inflammation among heart failure patients on peritoneal dialysis. Membr. 2022;12(3):318. doi:10.3390/membranes12030318
18. Cai L, Yu J, Yu J, Peng Y, Ullah H, Yi C, et al. Prognostic value of inflammation-based prognostic scores on outcome in patients undergoing continuous ambulatory peritoneal dialysis. BMC Nephrol. 2018;19:1–10. doi:10.1186/s12882-018-1092-1
19. Trionfetti F, Marchant V, González-Mateo GT, Kawka E, Márquez-Expósito L, Ortiz A, et al. Novel aspects of the immune response involved in the peritoneal damage in chronic kidney disease patients under dialysis. Int J Mol Sci. 2023;24(6):5763. doi:10.3390/ijms24065763
20. Ambarsari CG, Trihono PP, Kadaristiana A, Tambunan T, Mushahar L, Puspitasari HA, et al. Five-year experience of continuous ambulatory peritoneal dialysis in children: a single center experience in a developing country. Med J Indones. 2019;28(4):329–37. doi:10.13181/mji.v28i4.3807
21. Ramil-Gómez O, Rodríguez-Carmona A, Fernández-Rodríguez JA, Pérez-Fontán M, Ferreiro-Hermida T, López-Pardo M, et al. Mitochondrial dysfunction plays a relevant role in pathophysiology of peritoneal membrane damage induced by peritoneal dialysis. Antioxidants. 2021;10(3):447. doi:10.3390/antiox10030447
22. Morelle J, Stachowska-Pietka J, Öberg C, Gadola L, Milia V, Yu Z, et al. ISPD recommendations for the evaluation of peritoneal membrane dysfunction in adults: classification, measurement, interpretation and rationale for intervention. Perit Dial Int. 2021;41(4):352–72. doi:10.1177/0896860820982218
23. Salzer WL. Peritoneal dialysis-related peritonitis: challenges and solutions. Int J Nephrol Renov Dis. 2018;11:173–86. doi:10.2147/ijnrd.s123618
24. Htay H, Johnson DW, Craig JC, Teixeira-Pinto A, Hawley CM, Cho Y. Urgent‐start peritoneal dialysis versus conventional‐start peritoneal dialysis for people with chronic kidney disease. Cochrane Database Syst Rev. 2020;12(12):CD012913. doi:10.1002/14651858.cd012913.pub2
25. Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. Lancet. 2021;398(10302):786–802. doi:10.1016/s0140-6736(21)00519-5
26. Chuasuwan A, Pooripussarakul S, Thakkinstian A, Ingsathit A, Pattanaprateep O. Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. Heal Qual Life Outcomes. 2020;18:1–11. doi:10.1186/s12955-020-01449-2
27. Peso G Del, Bajo MA, Costero O, Hevia C, Gil F, Díaz C, et al. Risk factors for abdominal wall complications in peritoneal dialysis patients. Perit Dial Int. 2003;23(3):249–254. doi:10.1177/089686080302300306
28. Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, V PJ, Wilkie M, et al. Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update. Perit Dial Int. 2019;39(5):414–36. doi:10.3747/pdi.2018.00232
29. Zhang Q, Wu P, Xie J, Li X, Xu T, Huang X, et al. Rapid initiation of peritoneal dialysis by automated peritoneal dialysis or hemodialysis: A randomized clinical trial. Kidney Dis. 2023;9(6):529–37. doi:10.1159/000534334
30. Cho Y, Bello AK, Levin A, Lunney M, Osman MA, Ye F, et al. Peritoneal dialysis use and practice patterns: An international survey study. Am J Kidney Dis. 2021;77(3):315–25. doi:10.1053/j.ajkd.2020.05.032
31. Teitelbaum I. Peritoneal dialysis. N Engl J Med. 2021;385(19):1786–95. doi:10.1056/nejmra2100152
32. Balda S, Power A, Papalois V, Brown E. Impact of hernias on peritoneal dialysis technique survival and residual renal function. Perit Dial Int. 2013;33(6):629–634. doi:10.3747/pdi.2012.00255
33. Flythe JE, Watnick S. Dialysis for chronic kidney failure: A review. JAMA. 2024;332(18):1559–73. doi:10.1001/jama.2024.16338
34. Prakash J, Singh LS, Shreeniwas S, Ghosh B, Singh T. Non-infectious complications of continuous ambulatory peritoneal dialysis and their impact on technique survival. Indian J Nephrol. 2011;21(2):112–5. doi:10.4103/0971-4065.82125
35. Morris PJ. Kidney transplantation - principles and practice. 2020. 1–768 p. doi:10.1016/c2016-0-01606-6
36. Giles HE, Parameswaran V, Lasky R. Trends in automated peritoneal dialysis prescriptions in a large dialysis organization in the United States. Clin J Am Soc Nephrol. 2024;19(6):723–731. doi:10.2215/cjn.0000000000000436
Published
2025-08-24
How to Cite
1.
Yogiswara KS, Widhiarta PR, Kandarini Y, Puspitasari M, Kertia N. Automated Peritoneal Dialysis Versus Continuous Ambulatory Peritoneal Dialysis For People With Kidney Failure: A Review. inakidney [Internet]. 24Aug.2025 [cited 5Mar.2026];2(2):81-2. Available from: https://inakidneyhypertension.co.id/index.php/inakidney/article/view/186
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