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Keywords

Automated peritoneal dialysis machine, Peritoneal dialysis, End-stage renal disease, Universal health coverage scheme

Abstract

Background: Thailand had implemented the peritoneal dialysis first (PD first) policy which allowed access to peritoneal dialysis as a first-line treatment for end-stage renal disease (ESRD). However, all the patients under this policy are allowed to use only the self-operated Continuous Ambulatory Peritoneal Dialysis (CAPD) but not the Automated Peritoneal Dialysis (APD). While APD has a lot of advantages over CAPD, its cost is more than double in Thailand. Under these circumstances, it is crucial to produce APD equipment with a trade-off between good performance and affordable price.

Methods: This study is a pilot cross-sectional study to evaluate the operability and safety of the domestically developed APD machine. Three stable ESRD patients already treated with APD machines were recruited for the 7-day trial.

Results: There is a slight decrease in the dwell time due to the longer operational time of the developed machine; 11.26 ± 2.29%. Increases in serum creatinine and blood urea nitrogen were observed; 3.01 ± 1.83% and 22.92 ± 4.48%, respectively. No major adverse events were reported.

Conclusion: The developed machine used only gravity for the exchange, the dwell time was decreased as expected, resulting in a lower exchange of the waste products from the blood to the peritoneal cavity. Even though the results show a slightly lower treatment performance, no clinical significance during short-term follow-up was observed. To obtain similar performance for the domestically developed APD machine, total treatment time could be increased to maintain comparable dwell time overnight.

References

  1. Li PK, Chow KM, Van de Luijtgaarden MW, et al. Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol. 2017;13(2):90-103.
  2. Navva PK, Venkata Sreepada S, Shivanand Nayak K. Present Status of Renal Replacement Therapy in Asian Countries. Blood Purif. 2015;40(4):280-287.
  3. Chuengsaman P, Kasemsup V. PD First Policy: Thailand's Response to the Challenge of Meeting the Needs of Patients With End-Stage Renal Disease. Semin Nephrol. 2017;37(3):287-295.
  4. Teerawattananon Y, Luz A, Pilasant S, et al. How to meet the demand for good quality renal dialysis as part of universal health coverage in resource-limited settings? Health Res Policy Syst. 2016;14:21.
  5. Chuasuwan A, Lumpaopong A. Thailand Renal Replacement Therapy: Year 2015. The Nephrology Society of Thailand. 2015.
  6. Negoi D, Nolph KD. Automated peritoneal dialysis-indications and management. Contrib Nephrol. 2006;150:278-284.
  7. Chaudhry RI, Golper TA. Automated cyclers used in peritoneal dialysis: technical aspects for the clinician. Med Devices (Auckl). 2015;8:95-102.
  8. Yishak A, Bernardini J, Fried L, et al. The outcome of peritonitis in patients on automated peritoneal dialysis. Adv Perit Dial. 2001;17:205-208.
  9. Piraino B, Sheth H. Peritonitis-does peritoneal dialysis modality make a difference? Blood Purif. 2010;29(2):145-149.
  10. Rodriguez AM, Diaz NV, Cubillo LP, et al. Automated peritoneal dialysis: a Spanish multicentre study. Nephrol Dial Transplant. 1998;13(9):2335-2340.
  11. Dell'Aquila R, Berlingo G, Pellanda MV, et al. Continuous ambulatory peritoneal dialysis and automated peritoneal dialysis: are there differences in outcome? Contrib Nephrol. 2009;163:292-299.
  12. Thaweethamcharoen T, Sritippayawan S, Noparatayaporn P, et al. Cost-Utility Analysis of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis for Thai End-Stage Renal Disease Patients. Value Health Reg Issues. 2020;21:181-187.

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