[Adequate peritoneal dialysis: limitations of continuous ambulatory peritoneal dialysis (CAPD), place of automated peritoneal dialysis (APD)].

Recent epidemiological studies show a slowing down of the global growth of CAPD which is not compensated by the considerable development of APD. These modifications are the result of the arrival of technologies which allow new strategies as well as an improved knowledge of the adequate dialysis dose for PD. The re-evaluation of the adequate clearance targets show that CAPD does not deliver an adequate dialysis dose for anuric patients but it remains an excellent technique for patients with residual renal function. APD and mixed techniques (APD with automated diurnal exchange(s), CAPD with automated nocturnal exchange) can deliver an adequate dialysis dose if the peritoneal permeability is not too low and if the prescription is adapted to each patient. The growth of CAPD seems to be slowing down due to a better knowledge of its limitations. However the development of APD does not seem to be related to the increasing knowledge of its possibilities. The development of automated techniques, prescribed as substitute treatments, depends on a precise evaluation of the cost/efficiency/quality of life index, compared to the reference treatment which is iterative hemodialysis.